Provider Demographics
NPI:1306233739
Name:HORMES, EVELIA ALEJANDRA (PA)
Entity type:Individual
Prefix:
First Name:EVELIA
Middle Name:ALEJANDRA
Last Name:HORMES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST NE STE 1600
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2246
Mailing Address - Country:US
Mailing Address - Phone:404-881-1094
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE STE 1600
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2246
Practice Address - Country:US
Practice Address - Phone:404-881-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1124543363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical