Provider Demographics
NPI:1023550696
Name:ROSS, ANTRANIKA D (NP)
Entity Type:Individual
Prefix:MISS
First Name:ANTRANIKA
Middle Name:D
Last Name:ROSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 ACORN DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4703
Mailing Address - Country:US
Mailing Address - Phone:678-749-5702
Mailing Address - Fax:
Practice Address - Street 1:33 UPPER RIVERDALE RD SW STE 107
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2642
Practice Address - Country:US
Practice Address - Phone:678-489-6734
Practice Address - Fax:888-497-4760
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-13
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN202316363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology