Healthcare Provider Details

I. General information

NPI: 1659264331
Provider Name (Legal Business Name): DAIJA DENNIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2025
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 CLIFTON RD NE
ATLANTA GA
30332-0001
US

IV. Provider business mailing address

1520 CLIFTON RD NE
ATLANTA GA
30332-0001
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-7980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN311791
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: