Healthcare Provider Details

I. General information

NPI: 1568627255
Provider Name (Legal Business Name): ANDERIA SHIRRELL RHODES-BIGHAM N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 CANDLER RD SUITE 9
DECATUR GA
30034-1415
US

IV. Provider business mailing address

1703 CHINABERRY CT
STOCKBRIDGE GA
30281-9109
US

V. Phone/Fax

Practice location:
  • Phone: 404-243-9630
  • Fax: 404-243-8721
Mailing address:
  • Phone: 404-310-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN066876 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: