MEDICARE: MISS ANTRANIKA D. ROSS N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	RN202316	GA
2	363LG0600X	Gerontology Nurse Practitioner	RN202316	GA
3	363LP2300X	Primary Care Nurse Practitioner	RN202316	GA

General Provider Information

NPI Number	:	1023550696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANTRANIKA D. ROSS N.P.

Provider Business Mailing Address
First Line	:	145 ACORN DR
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-4703
Country	:	US
Telephone Number	:	678-749-5702
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 UPPER RIVERDALE RD SW STE 107
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2642
Country	:	US
Telephone Number	:	678-489-6734
Fax Number	:	888-497-4760

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2016
Last Update Date	:	01/10/2024

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