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General NPI Number Information
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NPI Number | 1417816612
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Entity Type | Individual
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Provider Name | DESTINY DANIELLE NELSON NP
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Gender | Female
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Dates
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Enumeration Date | 01/21/2026
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 345 HUNTINGTON PLACE CT
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City | MCDONOUGH
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State | GA
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Zip | 30253-8651
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Country | US
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Telephone | 678-782-6920
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Fax |
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Provider Business Mailing Address
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Address Line | 675 LAFAYETTE AVE APT 5112
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-8811
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Country | US
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Telephone | 337-335-7487
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | APRN-NP712281
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License Number State | GA
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