MEDICARE: ELDINE GARRAUD FNP

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	363LF0000X	Family Nurse Practitioner	GAA-NP001599	GA

General Provider Information

NPI Number	:	1992589691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELDINE GARRAUD FNP

Provider Business Mailing Address
First Line	:	2782 N COBB PKWY
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30152-3472
Country	:	US
Telephone Number	:	770-420-1092
Fax Number	:

Provider Business Practice Location Address
First Line	:	2782 N COBB PKWY
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30152-3472
Country	:	US
Telephone Number	:	770-420-1092
Fax Number	:

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

Provider Enumeration Date	:	08/23/2023
Last Update Date	:	06/01/2026

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