Healthcare Provider Details

I. General information

NPI: 1194550632
Provider Name (Legal Business Name): ERIKA KOREDJIAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 BRASELTON HWY STE 104
DACULA GA
30019-4696
US

IV. Provider business mailing address

5767 OLD WINDER HWY
BRASELTON GA
30517-1603
US

V. Phone/Fax

Practice location:
  • Phone: 678-347-2153
  • Fax:
Mailing address:
  • Phone: 678-865-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN259444
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: