Healthcare Provider Details

I. General information

NPI: 1336075431
Provider Name (Legal Business Name): IANDYA CARLISA TROTMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1269 WELLBROOK CIR NE
CONYERS GA
30012-3873
US

IV. Provider business mailing address

1269 WELLBROOK CIR NE
CONYERS GA
30012-3873
US

V. Phone/Fax

Practice location:
  • Phone: 770-922-0505
  • Fax: 678-625-5137
Mailing address:
  • Phone: 770-922-0505
  • Fax: 678-625-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP280651
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: