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Individual

ALICE FAIR FRANKLIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
835 COGBURN AVE NW STE 100, MARIETTA, GA 30060-1008
(770) 422-5557
(770) 422-5456
Mailing address
835 COGBURN AVENUE NW, SUITE 250, MARIETTA, GA 30060-1031
(770) 422-8815
(770) 422-8816

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
002375
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
002375
STATE LICENSE PA
GA
Enumeration date
08/30/2006
Last updated
06/25/2020
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