Healthcare Provider Details

I. General information

NPI: 1669100418
Provider Name (Legal Business Name): ALEXANDRA MARIA ACKERMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 OAK HILL BLVD STE 200
NEWNAN GA
30265-2313
US

IV. Provider business mailing address

531 WITCHER RD
NEWNAN GA
30263-4640
US

V. Phone/Fax

Practice location:
  • Phone: 770-304-0987
  • Fax:
Mailing address:
  • Phone: 262-758-1654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN283458
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN283458
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: