Healthcare Provider Details

I. General information

NPI: 1336075431
Provider Name (Legal Business Name): IANDYA TROTMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

7229 WHEAT ST NE
COVINGTON GA
30014-1566
US

IV. Provider business mailing address

115 OVERLOOK DR
MCDONOUGH GA
30252-2953
US

V. Phone/Fax

Practice location:
  • Phone: 678-625-5132
  • Fax:
Mailing address:
  • Phone: 770-670-1193
  • Fax: 770-670-1193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License NumberRN280651
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: