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General NPI Number Information
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NPI Number | 1225159155
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN GYNECOLOGIC ONCOLOGY ,LLC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 01/17/2012
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Provider Practice Location Address
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Address Line | 980 JOHNSON FERRY RD NE STE 900
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City | ATLANTA
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State | GA
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Zip | 30342-4768
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Country | US
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Telephone | 678-420-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 980 JOHNSON FERRY RD NE STE 900
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City | ATLANTA
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State | GA
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Zip | 30342-4768
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Country | US
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Telephone | 678-420-4100
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. NAN CORDIER
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Credential | APRN
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Telephone | 678-420-4195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN118553 NP
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License Number State | GA
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