Healthcare Provider Details

I. General information

NPI: 1407960115
Provider Name (Legal Business Name): DORIS E PORTER-BANKS CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DORIS E BANKS CNS

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CUMBERLAND PKWY SE KP CUMBERLAND MEDICAL OFFICE
ATLANTA GA
30339-3915
US

IV. Provider business mailing address

3495 PIEDMONT RD NE NINE PIEDMONT CENTER
ATLANTA GA
30305-1773
US

V. Phone/Fax

Practice location:
  • Phone: 770-431-4235
  • Fax:
Mailing address:
  • Phone: 404-364-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN086314
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: