Provider Demographics
NPI:1033115142
Name:BOSSIE, ANDREA LOGAN (MS, RN, CNN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LOGAN
Last Name:BOSSIE
Suffix:
Gender:F
Credentials:MS, RN, CNN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3560 LAUREL SPRINGS CV
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-3389
Mailing Address - Country:US
Mailing Address - Phone:770-459-8474
Mailing Address - Fax:
Practice Address - Street 1:1968 PEACHTREE RD NW
Practice Address - Street 2:BLDG 77 5TH FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1281
Practice Address - Country:US
Practice Address - Phone:404-605-2139
Practice Address - Fax:404-609-6810
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN112876NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ12836Medicare UPIN
GA50BBHHRMedicare ID - Type Unspecified