Individual provider · Type 1 NPI
Irina Sidorenko
Surgical Physician Assistant · Grayson, GA
NPI number
1740898279
Active
Practice location
2311 Ridge Forest Dr
Grayson, GA 30017-1718
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Surgery Physician | 208600000X | 20299 (GA) |
| Surgical Physician Assistant Primary | 363AS0400X | 20-299 (GA) |
Surgical Physician Assistant: Definition to come...
Another provider at this address
About NPI 1740898279
Irina Sidorenko's National Provider Identifier is 1740898279, issued on Jul 21, 2020. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Grayson, GA. The record was last updated on Nov 19, 2021.