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General NPI Number Information
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NPI Number | 1417152794
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Entity Type | Individual
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Provider Name | PANYA RENEE NASH LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 1670 CLAIRMONT RD
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City | DECATUR
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State | GA
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Zip | 30033-4004
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Country | US
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Telephone | 404-321-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 670 ESCALADE DR
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City | COLLEGE PARK
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State | GA
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Zip | 30349-2508
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Country | US
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Telephone | 706-536-9523
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW003736
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003917
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License Number State | GA
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