Provider Demographics
NPI:1306575899
Name:GARREAU, HILARY ELISE (PA-C)
Entity type:Individual
Prefix:
First Name:HILARY
Middle Name:ELISE
Last Name:GARREAU
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 1:3524 WINDRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2657
Mailing Address - Country:US
Mailing Address - Phone:404-547-6329
Mailing Address - Fax:
Practice Address - Street 1:9420 WILLEO RD STE 206
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-6773
Practice Address - Country:US
Practice Address - Phone:470-267-1520
Practice Address - Fax:770-999-2673
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10861363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10861OtherPHYSICIAN ASSISTANT LICENSE GEORGIA COMPOSITE MEDICAL BOARD
1192287OtherNATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS