Individual
ANDREA NABILA KHAIRUNISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
80 JESSE HILL JR DR SE, ATLANTA, GA 30303-3050
(404) 616-1000
Mailing address
2801 MOLLY DR, LAWRENCEVILLE, GA 30044-5280
(404) 769-8320
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
12776
GA
207R00000X
Internal Medicine Physician
Primary
12776
GA
363A00000X
Physician Assistant
12776
GA
Other
Enumeration date
05/05/2023
Last updated
01/22/2025
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