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NPI Code Detail

MEDICARE: MRS. BETHANY ANDERSON AGACNP

MEDICARE: MRS. BETHANY ANDERSON AGACNP
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
1363LA2100XAcute Care Nurse PractitionerRN247397GA

General Provider Information

NPI Number : 1992538540
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BETHANY ANDERSON AGACNP
Provider Business Mailing Address
First Line : 305 RIVERSONG WAY
Second Line :
City : ALPHARETTA
State : GA
Zip : 30022-1832
Country : US
Telephone Number : 803-571-4648
Fax Number :
Provider Business Practice Location Address
First Line : 5671 PEACHTREE DUNWOODY RD STE 300
Second Line :
City : ATLANTA
State : GA
Zip : 30342-5003
Country : US
Telephone Number : 404-778-6070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2024
Last Update Date : 08/20/2024

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