Provider Demographics
NPI:1043679913
Name:AVILA, ANDREA ISAMAR (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ISAMAR
Last Name:AVILA
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:ISAMAR
Other - Last Name:NAJARRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2378 IRON HORSE DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1383
Mailing Address - Country:US
Mailing Address - Phone:678-899-3556
Mailing Address - Fax:
Practice Address - Street 1:4166 BUFORD HWY NE
Practice Address - Street 2:SUITE 1102
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-1081
Practice Address - Country:US
Practice Address - Phone:404-785-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN243475363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics