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General NPI Number Information
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NPI Number | 1013546662
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Entity Type | Individual
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Provider Name | SHAHNAZ MULLA PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 2151 PEACHFORD RD
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City | ATLANTA
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State | GA
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Zip | 30338-6599
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Country | US
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Telephone | 770-455-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 22024 GARDNER DR
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City | ALPHARETTA
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State | GA
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Zip | 30009-2186
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Country | US
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Telephone | 914-690-4906
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN252331
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN252331
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License Number State | GA
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