Healthcare Provider Details

I. General information

NPI: 1942032651
Provider Name (Legal Business Name): NATHAN FRANCIS JANIK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 DURALEIGH RD
RALEIGH NC
27612-8106
US

IV. Provider business mailing address

2000 HOWARD FARM DR STE 200
CUMMING GA
30041-6081
US

V. Phone/Fax

Practice location:
  • Phone: 919-220-5255
  • Fax:
Mailing address:
  • Phone: 770-758-8964
  • Fax: 770-292-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13587
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-14729
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: