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General NPI Number Information
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NPI Number | 1841880705
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Entity Type | Individual
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Provider Name | ANITA PRINCE FNP
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Gender | Female
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Dates
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Enumeration Date | 01/24/2021
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 1003 HALEY WOODS LN
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-7331
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Country | US
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Telephone | 678-619-7643
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Fax | 678-359-9966
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Provider Business Mailing Address
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Address Line | 1398 CHRISTIANA DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5210
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Country | US
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Telephone | 678-353-8528
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Fax | 678-359-9966
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN218843
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License Number State | GA
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