Provider Demographics
NPI:1578348017
Name:AUTRY, ANNALEIGH GRACE
Entity type:Individual
Prefix:
First Name:ANNALEIGH
Middle Name:GRACE
Last Name:AUTRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 DULUTH HWY STE B
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5319
Mailing Address - Country:US
Mailing Address - Phone:470-610-6165
Mailing Address - Fax:470-610-6159
Practice Address - Street 1:918 DULUTH HWY STE B
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5319
Practice Address - Country:US
Practice Address - Phone:470-610-6165
Practice Address - Fax:470-610-6159
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant