Healthcare Provider Details

I. General information

NPI: 1134285166
Provider Name (Legal Business Name): LASHANDRA HOPSON NURSE PRACTIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COLLEGE PARK HEALTH CENTER 1920 JOHN WESLEY AVE
COLLEGE PARK GA
30349
US

IV. Provider business mailing address

99 JESSIE HILL DR RM 402
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-765-4155
  • Fax: 414-765-4149
Mailing address:
  • Phone: 404-730-1217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN081261NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: