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Individual

MISS LORENA A. CASTILLO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1505 NORTHSIDE BLVD STE 4600, CUMMING, GA 30041-7658
(770) 205-5292
(404) 205-5291
Mailing address
1835 SAVOY DR STE 300, ATLANTA, GA 30341-1071
(404) 256-4777
(404) 256-5515

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7131
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003176164D
GA
05
003176164E
GA
01
G15813B
MEDICARE PTAN
GA
Enumeration date
02/05/2015
Last updated
07/19/2022
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