Healthcare Provider Details

I. General information

NPI: 1114264694
Provider Name (Legal Business Name): AYNADDIS FEKADU FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 KING AVE SUITE 200
ATHENS GA
30606-6734
US

IV. Provider business mailing address

1835 SAVOY DR STE 300
ATLANTA GA
30341-1071
US

V. Phone/Fax

Practice location:
  • Phone: 706-369-4478
  • Fax: 706-353-6639
Mailing address:
  • Phone: 706-369-4478
  • Fax: 706-353-6639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP226586
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN226586
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: