Individual
IVY AKUA FENIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4120 AUSTELL RD, AUSTELL, GA 30106-1841
(678) 732-1500
Mailing address
PO BOX 102038, ATLANTA, GA 30368-2038
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
RN185101
GA
363L00000X
Nurse Practitioner
Primary
RN185101
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN185101
RN
GA
Enumeration date
05/03/2016
Last updated
03/27/2024
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