Individual
MISS LETITIA W PRICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
132 OLD NORTON RD, SUITE 200, FAYETTEVILLE, GA 30215-4872
(678) 817-1117
(678) 817-0823
Mailing address
1835 SAVOY DR, SUITE 300, ATLANTA, GA 30341-1072
(770) 495-3396
(770) 495-2307
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
005009
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
747792658A
—
GA
01
—
CA9328
MEDICARE GROUP-DMERC
GA
Enumeration date
03/12/2007
Last updated
01/13/2011
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