MEDICARE: BEATRICE ANIH NDE 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	363LA2100X	Acute Care Nurse Practitioner	RN149109	GA

General Provider Information

NPI Number	:	1659529303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATRICE ANIH NDE NP

Provider Business Mailing Address
First Line	:	1655 MILLHOUSE LNDG
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-8032
Country	:	US
Telephone Number	:	678-494-5842
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 NORTHSIDE CHEROKEE BLVD STE 130
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-8017
Country	:	US
Telephone Number	:	678-493-2527
Fax Number	:

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

Provider Enumeration Date	:	09/07/2008
Last Update Date	:	08/11/2020

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