Healthcare Provider Details

I. General information

NPI: 1174446843
Provider Name (Legal Business Name): VETTRELL ADAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 PEACHTREE PARK DR NE
ATLANTA GA
30309-1304
US

IV. Provider business mailing address

2013 CEDARBRIDGE AVE
LAKEWOOD NJ
08701-7050
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-6041
  • Fax:
Mailing address:
  • Phone: 732-519-0997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP280358
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: