Provider Demographics
NPI:1790922144
Name:ATTLES, MARGO D (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARGO
Middle Name:D
Last Name:ATTLES
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 1:4300 PACES FERRY RD SE STE 170
Mailing Address - Street 2:
Mailing Address - City:VININGS
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5705
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:4300 PACES FERRY RD SE
Practice Address - Street 2:
Practice Address - City:VININGS
Practice Address - State:GA
Practice Address - Zip Code:30339-5703
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002725363A00000X
MAPA5950363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100002249AMedicaid