Healthcare Provider Details

I. General information

NPI: 1386003986
Provider Name (Legal Business Name): THANDEKA THELMA NTULI MSN, APRN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 HURRICANE SHOALS ROAD N.W. SUITE 100
LAWRENCEVILLE GA
30046-8762
US

IV. Provider business mailing address

595 HURRICANE SHOALS ROAD N.W. SUITE 100
LAWRENCEVILLE GA
30046-8762
US

V. Phone/Fax

Practice location:
  • Phone: 404-645-7150
  • Fax: 770-339-4797
Mailing address:
  • Phone: 404-645-7150
  • Fax: 770-339-4797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN174000
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: