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General NPI Number Information
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NPI Number | 1265563803
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Entity Type | Individual
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Provider Name | IRINA M KNUDSEN N.P.
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 975 JOHNSON FERRY RD NE SUITE 460
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City | ATLANTA
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State | GA
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Zip | 30342-1619
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Country | US
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Telephone | 404-832-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 2384 WATERFORD CV
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City | DECATUR
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State | GA
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Zip | 30033-1332
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Country | US
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Telephone | 404-353-0869
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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 | RN139660
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License Number State | GA
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