Provider Demographics
NPI:1952719320
Name:MAXWELL, CECILIA (PA-C)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 CUMBERLAND PKWY SE APT 10206
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4575
Mailing Address - Country:US
Mailing Address - Phone:901-848-6055
Mailing Address - Fax:
Practice Address - Street 1:2292 PEACHTREE RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1147
Practice Address - Country:US
Practice Address - Phone:404-996-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8407363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant