Skip Navigation

Provider Information for 1881611663

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1881611663

Calendar   Last Updated:  2011-09-26
  Certification Date: 


Name Value
NPI 1881611663
Enumeration Date 2006-07-16
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 6633 EASTBRIAR DR
LITHONIA, GA 30058-8945
United States

Phone: 770-484-1802 | Fax:
View Map External Link
Primary Practice Address 1990 LAKESIDE PKWY SUITE 170
TUCKER, GA 30084-5884
United States

Phone: 770-938-1757 | Fax: 770-938-1759
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LF0000X - Nurse Practitioner Family GA RN066854