Provider Demographics
NPI:1831392349
Name:BANYA, MARKEITA LANEICE (PA)
Entity type:Individual
Prefix:MRS
First Name:MARKEITA
Middle Name:LANEICE
Last Name:BANYA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 KNOX SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-6313
Mailing Address - Country:US
Mailing Address - Phone:404-303-2323
Mailing Address - Fax:
Practice Address - Street 1:5580 ROSWELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-1861
Practice Address - Country:US
Practice Address - Phone:404-303-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA03495363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant