MEDICARE: NIA IMANI WHITE PMHNP-BC

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	272668	GA

General Provider Information

NPI Number	:	1376374918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIA IMANI WHITE PMHNP-BC

Provider Business Mailing Address
First Line	:	990 HAMMOND DR STE 600
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5510
Country	:	US
Telephone Number	:	678-861-1832
Fax Number	:

Provider Business Practice Location Address
First Line	:	990 HAMMOND DR STE 600
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-5510
Country	:	US
Telephone Number	:	678-861-1832
Fax Number	:

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

Provider Enumeration Date	:	08/13/2024
Last Update Date	:	05/07/2026

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