Healthcare Provider Details

I. General information

NPI: 1437997285
Provider Name (Legal Business Name): LIUDMILA DZMITRANITSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 JOHNSON FY RD NE STE 220
ATLANTA GA
30342-1623
US

IV. Provider business mailing address

4771 LAUREL WALK
DUNWOODY GA
30338-4730
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-5956
  • Fax:
Mailing address:
  • Phone: 404-232-5043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP288352
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: