Healthcare Provider Details

I. General information

NPI: 1205429941
Provider Name (Legal Business Name): MIRIANDA NDAPTSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2021
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 EDGEFIELD DR SW
MARIETTA GA
30008-7665
US

IV. Provider business mailing address

3008 EDGEFIELD DR SW
MARIETTA GA
30008-7665
US

V. Phone/Fax

Practice location:
  • Phone: 678-497-5145
  • Fax:
Mailing address:
  • Phone: 678-497-5145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberGAA-NPO00690
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberGAA-NPO00690
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberGAA-NPO00690
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: