Healthcare Provider Details

I. General information

NPI: 1215610787
Provider Name (Legal Business Name): ANJANA KHADKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 LAWRENCEVILLE SUWANEE RD
SUWANEE GA
30024-6540
US

IV. Provider business mailing address

3255 LAWRENCEVILLE SUWANEE RD STE P
SUWANEE GA
30024-6599
US

V. Phone/Fax

Practice location:
  • Phone: 470-780-1575
  • Fax: 770-727-2159
Mailing address:
  • Phone: 720-568-9138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN305243
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: