Individual
MS. NADINE ANGELA ENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.C.
Contact information
Practice address
3620 MARTIN LUTHER KING JR DR SW, ATLANTA, GA 30331-3711
(404) 696-7300
(404) 699-3514
Mailing address
3620 MARTIN LUTHER KING JR DR SW, ATLANTA, GA 30331-3711
(404) 696-7300
(404) 699-3514
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004493
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
457877647A
—
GA
05
—
457877647B
—
GA
05
—
457877647C
—
GA
05
—
457877647D
—
GA
05
—
457877647E
—
GA
Enumeration date
11/07/2006
Last updated
09/27/2010
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