Healthcare Provider Details

I. General information

NPI: 1104302645
Provider Name (Legal Business Name): ALEXANDRA NICOLE PLEBANIAK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

1000 JOHNSON FERRY RD
ATLANTA GA
30342-1606
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-8000
  • Fax: 404-303-3759
Mailing address:
  • Phone: 404-851-8000
  • Fax: 404-303-3759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP005436
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: