Healthcare Provider Details

I. General information

NPI: 1144914391
Provider Name (Legal Business Name): AISHATU M HYPPOLITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3966 KINGSBROOK BLVD
DECATUR GA
30034-5747
US

IV. Provider business mailing address

3966 KINGSBROOK BLVD
DECATUR GA
30034-5747
US

V. Phone/Fax

Practice location:
  • Phone: 848-467-1259
  • Fax:
Mailing address:
  • Phone: 848-467-1259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN307598
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: