Healthcare Provider Details

I. General information

NPI: 1255948774
Provider Name (Legal Business Name): KATHERINE MARIE NELSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 N DRUID HILLS RD NE
ATLANTA GA
30329-3117
US

IV. Provider business mailing address

PO BOX 794
WOODSTOCK GA
30188-0794
US

V. Phone/Fax

Practice location:
  • Phone: 770-715-1798
  • Fax:
Mailing address:
  • Phone: 770-715-1798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN311471
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: