Healthcare Provider Details

I. General information

NPI: 1689188047
Provider Name (Legal Business Name): AVRIL LAURENDINE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 06/06/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5134 PEACHTREE RD
CHAMBLEE GA
30341-2724
US

IV. Provider business mailing address

5134 PEACHTREE RD
CHAMBLEE GA
30341-2724
US

V. Phone/Fax

Practice location:
  • Phone: 678-872-7100
  • Fax: 678-843-8501
Mailing address:
  • Phone: 678-872-7100
  • Fax: 678-843-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN217670
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: