Provider Demographics
NPI:1891529319
Name:HERRERA, MARIA DEL CARMEN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DEL CARMEN
Last Name:HERRERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 OAKBROOK PKWY
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-2256
Mailing Address - Country:US
Mailing Address - Phone:770-806-2928
Mailing Address - Fax:
Practice Address - Street 1:930 ASHLAND PARK WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-6807
Practice Address - Country:US
Practice Address - Phone:678-943-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363AM0700X
GA12735363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty