Provider Demographics
NPI:1912981143
Name:SCANNELLI, KATRINA DENISE (PA-C)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:DENISE
Last Name:SCANNELLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:DENISE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1915 E VICTORY DRIVE
Mailing Address - Street 2:SUITE E #1059
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404
Mailing Address - Country:US
Mailing Address - Phone:912-429-3749
Mailing Address - Fax:
Practice Address - Street 1:42 CHAUCER ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-3824
Practice Address - Country:US
Practice Address - Phone:912-429-3749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3469363AM0700X
363A00000X
PAMA064316363A00000X
MAPA3712363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001018701Medicare PIN