Individual
ELIZA MATTSON ANTONOWICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
595 HURRICANE SHOALS RD NW STE 300, LAWRENCEVILLE, GA 30046-8762
(770) 995-0823
Mailing address
5010 GALLATREE LN, PEACHTREE CORNERS, GA 30092-1218
(678) 654-0681
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN318173
GA
Other
Enumeration date
02/16/2023
Last updated
02/16/2023
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