Individual
SOUMMALA HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
80 JESSE HILL JR DR SE, ATLANTA, GA 30303-3031
(770) 377-1857
Mailing address
1181 FOUNTAIN HEAD CT, LAWRENCEVILLE, GA 30043-4790
(770) 377-1857
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
210744
GA
363LA2100X
Acute Care Nurse Practitioner
Primary
210744
GA
Other
Enumeration date
05/23/2017
Last updated
05/23/2017
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