Healthcare Provider Details

I. General information

NPI: 1265499255
Provider Name (Legal Business Name): NANCY LEE PERALTA RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: NANCY LEE DUNCAN RN, NP

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE FAMILY PLANNING CLINIC
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

126 W HILL ST
DECATUR GA
30030-4314
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-7927
  • Fax: 404-616-2292
Mailing address:
  • Phone: 404-377-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN053619 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: