Provider Demographics
NPI:1699171223
Name:BANKS, JULIE LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:BANKS
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 1:250 PARKBROOKE PL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-6400
Mailing Address - Country:US
Mailing Address - Phone:770-442-1911
Mailing Address - Fax:770-928-2601
Practice Address - Street 1:250 PARKBROOKE PL
Practice Address - Street 2:SUITE 300
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6400
Practice Address - Country:US
Practice Address - Phone:770-442-1911
Practice Address - Fax:770-928-2601
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA007403363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical