MEDICARE: LILLIAN MARIA NAGADDYA FNP-C

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	163W00000X	Registered Nurse	RN143664	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN143664	OTHER	GA	RN LICENSE
2	06081973	OTHER		BIRTH DATE

General Provider Information

NPI Number	:	1932306099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN MARIA NAGADDYA FNP-C

Provider Business Mailing Address
First Line	:	1203 CLEVELAND AVE
Second Line	:	SUITE 2-D
City	:	EAST POINT
State	:	GA
Zip	:	30344-3417
Country	:	US
Telephone Number	:	404-684-7111
Fax Number	:	404-684-7112

Provider Business Practice Location Address
First Line	:	1203 CLEVELAND AVE
Second Line	:	SUITE 2-D
City	:	EAST POINT
State	:	GA
Zip	:	30344-3417
Country	:	US
Telephone Number	:	404-684-7111
Fax Number	:	404-684-7112

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	07/08/2007

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