Healthcare Provider Details

I. General information

NPI: 1457851040
Provider Name (Legal Business Name): DZENETA KRNDZIJA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2980 SERENADE CT.
MILTON GA
30004
US

IV. Provider business mailing address

2050 CUMMING HWY
CANTON GA
30115-2314
US

V. Phone/Fax

Practice location:
  • Phone: 678-447-1646
  • Fax:
Mailing address:
  • Phone: 770-345-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN188955
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: