MEDICARE: FARDOUSA ARESS NP

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	363LF0000X	Family Nurse Practitioner	RN288016	GA

General Provider Information

NPI Number	:	1255210183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARDOUSA ARESS NP

Provider Business Mailing Address
First Line	:	2500 SHALLOWFORD RD NE APT 5316
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-1232
Country	:	US
Telephone Number	:	404-781-5065
Fax Number	:	470-781-9142

Provider Business Practice Location Address
First Line	:	660 MCWILLIAMS RD SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-7544
Country	:	US
Telephone Number	:	404-688-1350
Fax Number	:	470-781-9142

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

Provider Enumeration Date	:	08/27/2025
Last Update Date	:	06/09/2026

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