Healthcare Provider Details

I. General information

NPI: 1699242990
Provider Name (Legal Business Name): ERICKA FRANCIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 MARTIN LUTHER KING JR DR SW STE 12&22
ATLANTA GA
30311-1634
US

IV. Provider business mailing address

2039 RESERVE PKWY
MCDONOUGH GA
30253-7435
US

V. Phone/Fax

Practice location:
  • Phone: 770-933-6289
  • Fax:
Mailing address:
  • Phone: 404-751-7419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number267636
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: