MEDICARE: NOURISH ATL, LLC

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

General Provider Information

NPI Number	:	1396606224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOURISH ATL, LLC

Provider Business Mailing Address
First Line	:	2483 HERITAGE VLG STE 16-411
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-6140
Country	:	US
Telephone Number	:	470-784-1155
Fax Number	:	770-637-9380

Provider Business Practice Location Address
First Line	:	2245 WISTERIA DR STE 200
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-3799
Country	:	US
Telephone Number	:	770-637-9380
Fax Number	:	770-637-9380

Authorized Official
Title or Position	:	OWNER
Name	:	JOANNE PARKS
Credential	:	PMHNP-BC
Telephone Number	:	770-828-9340

Provider Enumeration Date	:	11/20/2025
Last Update Date	:	11/20/2025

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Directions to “NOURISH ATL, LLC ” Practice Location

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