Provider Demographics
NPI:1164666962
Name:GILES, CLARISSA ISABELLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:ISABELLE
Last Name:GILES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CLARISSA
Other - Middle Name:ISABELLE
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1611 SANDS PLACE
Mailing Address - Street 2:STE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067
Mailing Address - Country:US
Mailing Address - Phone:678-944-8042
Mailing Address - Fax:678-293-7579
Practice Address - Street 1:1611 SANDS PLACE
Practice Address - Street 2:STE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067
Practice Address - Country:US
Practice Address - Phone:678-944-8042
Practice Address - Fax:678-293-7579
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104959363AM0700X, 363AS0400X
GA8648363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical