Provider Demographics
NPI:1598249898
Name:ATTAWAY, EMILY R (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:ATTAWAY
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:R
Other - Last Name:GODFREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:460 N ORLANDO AVE
Practice Address - Street 2:STE 200 BLDG D
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2988
Practice Address - Country:US
Practice Address - Phone:407-898-5452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111641363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102294900Medicaid