Healthcare Provider Details

I. General information

NPI: 1548894264
Provider Name (Legal Business Name): NOUREEN THARWANI ALI DNP, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NOUREEN THARWANI RN

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 COSMOPOLITAN DR NE UNIT 302
ATLANTA GA
30324-3621
US

IV. Provider business mailing address

711 COSMOPOLITAN DR NE UNIT 302
ATLANTA GA
30324-3621
US

V. Phone/Fax

Practice location:
  • Phone: 678-559-6840
  • Fax:
Mailing address:
  • Phone: 678-559-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN242206
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN242206
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: