MEDICARE: CHANNA DELORIS ROCHESTER NURSE PRACTITIONER -

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN235085	GA

General Provider Information

NPI Number	:	1134428048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANNA DELORIS ROCHESTER NURSE PRACTITIONER -

Provider Business Mailing Address
First Line	:	1108 WAYNE DR
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2024
Country	:	US
Telephone Number	:	404-453-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	11O8 WAYNE DR
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078
Country	:	US
Telephone Number	:	404-453-8100
Fax Number	:

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

Provider Enumeration Date	:	03/17/2011
Last Update Date	:	03/12/2026

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