Healthcare Provider Details

I. General information

NPI: 1972829406
Provider Name (Legal Business Name): SUZANA SIMONISHVILI RN, ACNP -BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WHITCHER ST NE SUITE 420
MARIETTA GA
30060-1155
US

IV. Provider business mailing address

2768 CREEK VIEW CT NE
ROSWELL GA
30075-5428
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-1372
  • Fax:
Mailing address:
  • Phone: 770-552-5288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN179700
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: