Healthcare Provider Details

I. General information

NPI: 1861105884
Provider Name (Legal Business Name): EDEN ZERAI WOLDAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PEACHTREE INDUSTRIAL BLVD
SUWANEE GA
30024-6989
US

IV. Provider business mailing address

2620 ELM HILL PIKE
NASHVILLE TN
37214-3108
US

V. Phone/Fax

Practice location:
  • Phone: 770-831-3857
  • Fax:
Mailing address:
  • Phone: 615-425-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN270489
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: