MEDICARE: VANESSA MARIE SALEEM AGNP

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	363LA2200X	Adult Health Nurse Practitioner	4054928	KY
2	363LG0600X	Gerontology Nurse Practitioner	RN217587	GA
3	363LA2200X	Adult Health Nurse Practitioner	RN217587	GA
4	363LA2200X	Adult Health Nurse Practitioner	14276960-4405	UT

General Provider Information

NPI Number	:	1104477827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA MARIE SALEEM AGNP

Provider Business Mailing Address
First Line	:	280 COBB PKWY SE
Second Line	:	STE 60
City	:	MARIETTA
State	:	GA
Zip	:	30060-6531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 HOWELL MILL RD NW FL 8
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-5557
Country	:	US
Telephone Number	:	866-849-0692
Fax Number	:

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

Provider Enumeration Date	:	09/24/2019
Last Update Date	:	04/06/2026

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