Healthcare Provider Details

I. General information

NPI: 1194035485
Provider Name (Legal Business Name): MONICA MCKEON HANNAH PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 BRIARCLIFF RD NE
ATLANTA GA
30329-4010
US

IV. Provider business mailing address

1920 BRIARCLIFF RD NE
ATLANTA GA
30329-4010
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-9404
  • Fax: 404-785-9025
Mailing address:
  • Phone: 404-414-0442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number172832
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number15269
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number217488
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number217488
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: