Basic Information
| Provider Information | |||||||||
| NPI: | 1487629440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATCHISON | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | THERESA | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 OAKWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | OAKWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454192911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9378857163 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7073 CLYO RD | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454594816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374355857 | ||||||||
| FaxNumber: | 9379124960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 10/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 50-00-1815 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.