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General NPI Number Information
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NPI Number | 1023550696
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Entity Type | Individual
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Provider Name | ANTRANIKA D. ROSS N.P.
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Gender | Female
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Dates
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Enumeration Date | 11/13/2016
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 33 UPPER RIVERDALE RD SW STE 107
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City | RIVERDALE
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State | GA
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Zip | 30274-2642
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Country | US
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Telephone | 678-489-6734
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Fax | 888-497-4760
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Provider Business Mailing Address
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Address Line | 145 ACORN DR
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City | MCDONOUGH
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State | GA
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Zip | 30253-4703
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Country | US
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Telephone | 678-749-5702
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN202316
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | RN202316
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | RN202316
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License Number State | GA
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