MEDICARE: SYLVANUS AMANZE ANUFORO APRN FNP-C DNP

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	163WH0200X	Home Health Registered Nurse	RN175316	GA
2	363LF0000X	Family Nurse Practitioner	RN175316	GA
3	363LF0000X	Family Nurse Practitioner	95005802	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN175316	OTHER	GA	GEORGIA BOARD OF NURSING
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346630662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYLVANUS AMANZE ANUFORO APRN FNP-C DNP

Provider Business Mailing Address
First Line	:	280 MERCHANTS SQ
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30132-5029
Country	:	US
Telephone Number	:	404-717-7014
Fax Number	:	678-653-8224

Provider Business Practice Location Address
First Line	:	280 MERCHANTS SQ
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30132-5029
Country	:	US
Telephone Number	:	404-717-7014
Fax Number	:	770-577-3162

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

Provider Enumeration Date	:	01/24/2015
Last Update Date	:	02/21/2024

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