Healthcare Provider Details

I. General information

NPI: 1548857295
Provider Name (Legal Business Name): NATALIE WALDROP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 09/02/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE BLDG C
ATLANTA GA
30322-4404
US

IV. Provider business mailing address

609 VIRGINIA AVE NE APT 3106
ATLANTA GA
30306-3782
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3184
  • Fax:
Mailing address:
  • Phone: 334-275-0541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.1690
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14169
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number12206
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: