Provider Demographics
NPI:1851786420
Name:AGBENYEFIA, PRISCILLA (MD)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:AGBENYEFIA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3780 HOLCOMB BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4855
Mailing Address - Country:US
Mailing Address - Phone:470-275-3626
Mailing Address - Fax:828-483-5417
Practice Address - Street 1:3780 HOLCOMB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-4855
Practice Address - Country:US
Practice Address - Phone:470-275-3626
Practice Address - Fax:828-483-5417
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-02780207L00000X, 207LP2900X
390200000X
GA87539207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program