MEDICARE: MS. ANDREA ROCHE GAYDEN ANP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	RN208594	GA
2	363LA2200X	Adult Health Nurse Practitioner	RN208594	GA

General Provider Information

NPI Number	:	1053723676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA ROCHE GAYDEN ANP-BC

Provider Business Mailing Address
First Line	:	4120 FIVE FORKS TRICKUM RD SW STE 105
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-8975
Country	:	US
Telephone Number	:	770-921-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 FIVE FORKS TRICKUM RD SW STE 105
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-8975
Country	:	US
Telephone Number	:	770-921-6900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2014
Last Update Date	:	12/11/2025

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