Provider Demographics
NPI:1215265681
Name:TOUBIANA, ALICIA (PA-C)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:TOUBIANA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:MOHAMMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 HOSPITAL SOUTH DR STE 409
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8159
Mailing Address - Country:US
Mailing Address - Phone:770-732-9100
Mailing Address - Fax:770-528-9924
Practice Address - Street 1:1700 HOSPITAL SOUTH DR STE 409
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8159
Practice Address - Country:US
Practice Address - Phone:770-732-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5750363A00000X
363AM0700X
GA5753363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical