Provider Demographics
NPI:1285236877
Name:MICKLON, ANTHONY SCOTT (PA-C)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:SCOTT
Last Name:MICKLON
Suffix:
Gender:M
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 1:811 13TH ST STE 20
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2771
Mailing Address - Country:US
Mailing Address - Phone:706-722-3401
Mailing Address - Fax:706-434-6278
Practice Address - Street 1:811 13TH ST STE 20
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2771
Practice Address - Country:US
Practice Address - Phone:706-722-3401
Practice Address - Fax:706-434-6278
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10052363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant