MISS DEIDRA DYAN MUNSANTO (NPI# 1235432170) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235432170 |
| Entity Type | Individual |
| Full Name | MISS DEIDRA DYAN MUNSANTO |
| Other Name | MISS DEIDRA DYAN JOHNSON |
| Credential | PA-C |
| Practice Address |
12201 Highway 92 Ste D Woodstock GA 30188 |
| Mailing Address |
805 Sandy Plains Road Medical Staff Services Marietta GA 30066-6340 |
| Practice Telephone | 7705174621 |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2019-11-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | GA | Physician Assistants & Advanced Practice Nursing Providers | |
| N | 363A00000X | Physician Assistant | 1937 | OK | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1601 Sw 89th St Ste E200, Oklahoma City, OK 731596380 | 4057024435 | 4057024437 |
| Street Address |
12201 HIGHWAY 92 STE D |
| City | WOODSTOCK |
| State | GA |
| Zip Code | 30188 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841741493 | Bela Gandhi Mody | Nurse Practitioner | 12201 Highway 92 Ste D, Woodstock, GA 30188-7141 | 2016-10-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730715814 | Tyler Rose | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 116 South Mill Creek Court, Woodstock, GA 30188 | 2020-03-20 |
| 1881224897 | Dr. Tom LLC | Clinic/Center | 5431 Old Highway 5 Ste 206, Holly Springs, GA 30188 | 2020-01-17 |
| 1467090175 | Stacey Robin Hill | Dietitian, Registered | 210 Mcaffee St, Street Address 2, Woodstock, GA 30188 | 2019-12-12 |
| 1326681784 | Margo Vanderveen | Massage Therapist | 605 Old Hickory Road, Woodstock, GA 30188 | 2019-10-17 |
| 1275093437 | Rebekah Ruth Tchouta | Social Worker | 5166 Shotwell St, Woodstock, GA 30188 | 2019-03-23 |
| 1205395829 | Angela M Graves | Behavior Technician | 3229 S Cherokee Ln Ste 1400, Woodstock, GA 30188 | 2019-03-13 |
| 1396233391 | Costco Wholesale Corporation | Hearing Aid Equipment | 113 Lincoln Street, Woodstock, GA 30188 | 2018-04-25 |
| 1659878080 | Alexis K. Brown | Counselor | 3380 Trickum Rd., Bldg 700, Woodstock, GA 30188 | 2018-04-11 |
| 1427555440 | Lisa Marie Anthony | Specialist/Technologist | 400 Arnold Mill Rd, Woodstock, GA 30188 | 2018-04-06 |
| 1497254122 | J.a.h. Enterprises, LLC | Audiologist | 12195 Hwy. 92, Suite 114-325, Woodstock, GA 30188 | 2018-02-08 |
| Find all providers in zip 30188 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245838804 | Erin Washington | Physician Assistant | 2708 Tallowtree Rd, Woodstock, MD 21163-1462 | 2020-10-15 |
| 1083133912 | Amanda Bostock Sowisdral | Physician Assistant | 250 Parkbrooke Pl Ste 300, Woodstock, GA 30189 | 2017-09-12 |
| 1215476098 | Carina C Cardillo | Physician Assistant | 7559 South Main Street, Suite 310, Woodstock, VA 22664 | 2017-02-14 |
| 1659702884 | Dana Dunlap | Physician Assistant | 8814 Hwy 9, 114, Woodstock, GA 30189 | 2013-12-13 |
| 1306910187 | Denise Arlen Mcnatt | Physician Assistant | 10413 Saddlebred Trl, Woodstock, IL 60098-8672 | 2006-11-20 |
| 1689633414 | Bruce Alan Cavanaugh | Physician Assistant | 9987 Village Green Dr, Woodstock, MD 21163-1155 | 2006-03-21 |
| 1962484154 | Laura B Vahey | Physician Assistant | 32 Pleasant Street, Woodstock, VT 05091 | 2005-11-15 |
| 1356837348 | Jamie Ailed Quinones-borges | Physician Assistant | 7820 Hickory Flat Hwy, Woodstock, GA 30188-2099 | 2018-07-02 |
| 1841788734 | Christian Smith Galloway | Physician Assistant | 960 Woodstock Pkwy Ste 200, Woodstock, GA 30188-4867 | 2018-04-25 |
| 1114476553 | Alexandra Clifton | Physician Assistant | 28921 Highway 5, Woodstock, AL 35188-3613 | 2016-09-27 |
| Find all providers in WOODSTOCK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.