Provider Demographics
NPI:1699458240
Name:MEJIA, ALEXIS (PA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:MEJIA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3286 OLD SALEM RD SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2259
Mailing Address - Country:US
Mailing Address - Phone:404-481-0814
Mailing Address - Fax:
Practice Address - Street 1:3286 OLD SALEM RD SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2259
Practice Address - Country:US
Practice Address - Phone:404-481-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant