Healthcare Provider Details

I. General information

NPI: 1790408185
Provider Name (Legal Business Name): ARIELLE JESSICA SHETTY AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NORTHSIDE FORSYTH DR STE 250
CUMMING GA
30041-7701
US

IV. Provider business mailing address

2240 KILMINGTON SQ
ALPHARETTA GA
30009-8635
US

V. Phone/Fax

Practice location:
  • Phone: 770-889-7118
  • Fax: 770-844-7835
Mailing address:
  • Phone: 412-360-9569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number285862
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number285862
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number285862
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: