Healthcare Provider Details

I. General information

NPI: 1437330503
Provider Name (Legal Business Name): CLAUDETTE MINTO RYAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 RANKIN ST NE
ATLANTA GA
30308-2920
US

IV. Provider business mailing address

3417 BLAKE RIDGE CT
DACULA GA
30019-2772
US

V. Phone/Fax

Practice location:
  • Phone: 943-200-2010
  • Fax: 833-438-7708
Mailing address:
  • Phone: 646-522-3502
  • Fax: 770-762-7212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN-NP313605
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF304651
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: