Healthcare Provider Details

I. General information

NPI: 1841651254
Provider Name (Legal Business Name): AMELIA ST JOHN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 06/06/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CLIFTON RD NE
ATLANTA GA
30322-1060
US

IV. Provider business mailing address

1405 CLIFTON RD NE
ATLANTA GA
30322-1060
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-6565
  • Fax: 404-785-0058
Mailing address:
  • Phone: 404-785-6565
  • Fax: 404-785-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberRN207751
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: