Provider Demographics
NPI:1841855905
Name:TRAINA, ALISSA RAE
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:RAE
Last Name:TRAINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RAE
Other - Middle Name:
Other - Last Name:TRAINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:978 LINDBERGH DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3731
Mailing Address - Country:US
Mailing Address - Phone:678-777-0585
Mailing Address - Fax:
Practice Address - Street 1:978 LINDBERGH DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3731
Practice Address - Country:US
Practice Address - Phone:678-777-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-04
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9816363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant