Mrs Brena Johnson Siddall, PA-C is a medicare enrolled "Physician Assistant" in Mc Rae, Georgia. Her current practice location is
280 E Willow Creek Ln, Mc Rae, Georgia. You can reach out to her office (for appointments etc.) via phone at
(478) 864-3448.
Mrs Brena Johnson Siddall is licensed to practice in Georgia (license number 3400) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1790978526.
Provider's Profile
| Full Name | Mrs Brena Johnson Siddall |
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| Gender | Female |
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| Speciality | Physician Assistant |
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| Location | 280 E Willow Creek Ln, Mc Rae, Georgia |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1790978526
- Provider Enumeration Date: 08/24/2007
- Last Update Date: 08/20/2015
Medicare PECOS Information:
- PECOS PAC ID: 7810175015
- Enrollment ID: I20110616000462
Medical Identifiers
Medical identifiers for Mrs Brena Johnson Siddall such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1790978526 | NPI | - | NPPES |
| 003400 | Other | GA | GEORGIA LICENSE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363A00000X | Physician Assistant | 3400 (Georgia) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Brena Johnson Siddall is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mrs Brena Johnson Siddall, PA-C
2251 W Elm St,
Wrightsville, GA 31096-2017
Ph: (478) 864-3448 | Mrs Brena Johnson Siddall, PA-C
280 E Willow Creek Ln,
Mc Rae, GA 31055-5126
Ph: (478) 864-3448 |
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