Healthcare Provider Details

I. General information

NPI: 1417936386
Provider Name (Legal Business Name): RENICE ANDREA WASHINGTON MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 JOHNSON FERRY RD STE 910
ATLANTA GA
30342-1626
US

IV. Provider business mailing address

960 JOHNSON FERRY RD STE 130
ATLANTA GA
30342-1631
US

V. Phone/Fax

Practice location:
  • Phone: 404-303-3750
  • Fax: 404-252-4755
Mailing address:
  • Phone: 404-300-2990
  • Fax: 404-300-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN102681
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: