# KRISTY AYCINENA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629845680
- **Authorized official:** KRISTY AYCINENA CSFA (SURGICAL FIRST ASSISTANT)
- **Authorized official phone:** (678) 858-1980

## Contact information

- **Practice address:** 2856 WOODBRIAR DR, GAINESVILLE, GA 30506-2890
- **Practice address phone:** (678) 858-1980
- **Mailing address:** PO BOX 1604, GAINESVILLE, GA 30503-1604
- **Mailing address phone:** (678) 858-1980

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | — | NULL | Yes |
| 363AS0400X | Surgical Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 12/08/2023
- **Last updated:** 05/15/2024