Provider Demographics
NPI:1982063681
Name:AMBROSE, ANTHONY ROBERT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ROBERT
Last Name:AMBROSE
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1968 PEACHTREE RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1281
Mailing Address - Country:US
Mailing Address - Phone:404-605-2800
Mailing Address - Fax:404-367-3558
Practice Address - Street 1:1968 PEACHTREE RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1281
Practice Address - Country:US
Practice Address - Phone:404-605-2800
Practice Address - Fax:404-367-3558
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA007905363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical