Healthcare Provider Details

I. General information

NPI: 1922931401
Provider Name (Legal Business Name): ANDRINE TOUSSAINT LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 WATER CREST LN
CANTON GA
30114-1300
US

IV. Provider business mailing address

407 WATER CREST LN
CANTON GA
30114-1300
US

V. Phone/Fax

Practice location:
  • Phone: 706-352-0196
  • Fax: 706-352-0196
Mailing address:
  • Phone: 706-352-0196
  • Fax: 706-352-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN099760
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: