Healthcare Provider Details

I. General information

NPI: 1447975040
Provider Name (Legal Business Name): ANIA NICOLE BATEMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANIA NICOLE WALKER RN

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 NORTHLAND RD SW
MABLETON GA
30126-1663
US

IV. Provider business mailing address

407 NORTHLAND RD SW
MABLETON GA
30126-1663
US

V. Phone/Fax

Practice location:
  • Phone: 321-544-0643
  • Fax:
Mailing address:
  • Phone: 321-544-0643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN-NP212203
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN212203
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: