Provider Demographics
NPI:1164796009
Name:DE FREITAS, MARIA (PA-C)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DE FREITAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3146 STAGLIN DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-5079
Mailing Address - Country:US
Mailing Address - Phone:678-634-9303
Mailing Address - Fax:
Practice Address - Street 1:805 SANDY PLAINS RD
Practice Address - Street 2:WELLSTAR MEDICAL GROUP
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6340
Practice Address - Country:US
Practice Address - Phone:770-792-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061645363A00000X
GA004588363A00000X
NJ25MP00040500363A00000X
NY008438363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMP00040500OtherNJ PA LICENSE
NY008438OtherNY PA LICENSE
PAMA061645OtherPENNSYLVANIA PA LICENSE