Provider Demographics
NPI:1871585158
Name:MCINNIS, NANCY C (PA)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:C
Last Name:MCINNIS
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3715 NORTHSIDE PKWY NW STE 2-100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2809
Mailing Address - Country:US
Mailing Address - Phone:404-663-6130
Mailing Address - Fax:404-289-5362
Practice Address - Street 1:3715 NORTHSIDE PKWY NW STE 2-100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2809
Practice Address - Country:US
Practice Address - Phone:404-663-6130
Practice Address - Fax:404-289-5362
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA001704363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97BBCNR03Medicare ID - Type Unspecified