Healthcare Provider Details

I. General information

NPI: 1790233120
Provider Name (Legal Business Name): ETSUBDENKE AREAYA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2738 N DECATUR RD
DECATUR GA
30033-5910
US

IV. Provider business mailing address

2738 N DECATUR RD
DECATUR GA
30033-5910
US

V. Phone/Fax

Practice location:
  • Phone: 404-508-8058
  • Fax:
Mailing address:
  • Phone: 404-508-8058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN224247
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRNNP224247
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: