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General NPI Number Information
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NPI Number | 1376374918
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Entity Type | Individual
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Provider Name | NIA IMANI WHITE PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/13/2024
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 990 HAMMOND DR STE 600
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-5510
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Country | US
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Telephone | 678-861-1832
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Fax |
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Provider Business Mailing Address
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Address Line | 2066 BROADMOOR WAY
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City | FAIRBURN
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State | GA
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Zip | 30213-2697
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Country | US
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Telephone | 404-287-1673
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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 | 272668
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License Number State | GA
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