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General NPI Number Information
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NPI Number | 1134460207
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Entity Type | Individual
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Provider Name | GANIELLE HOOPER NP
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Gender | Female
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 2551 ROSWELL RD STE 420
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City | MARIETTA
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State | GA
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Zip | 30062-4761
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Country | US
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Telephone | 678-648-7888
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 WYNMONT DR
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City | MARIETTA
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State | GA
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Zip | 30062-4934
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Country | US
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Telephone | 301-385-3438
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 20171710
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN271087
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License Number State | GA
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