Healthcare Provider Details

I. General information

NPI: 1801033733
Provider Name (Legal Business Name): VIVIENNE NYAMBURA NDUATI-MOODY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 BOULEVARD NE SUITE 145
ATLANTA GA
30312-1273
US

IV. Provider business mailing address

550 PEACHTREE ST NE SUITE 1600
ATLANTA GA
30308-2247
US

V. Phone/Fax

Practice location:
  • Phone: 404-584-7306
  • Fax: 404-584-7308
Mailing address:
  • Phone: 404-881-1094
  • Fax: 404-885-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: