Provider Demographics
NPI:1194823799
Name:D'ANTIGNAC, VERONICA
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:D'ANTIGNAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8225 MALL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6996
Mailing Address - Country:US
Mailing Address - Phone:770-981-2100
Mailing Address - Fax:770-808-8445
Practice Address - Street 1:8225 MALL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-6996
Practice Address - Country:US
Practice Address - Phone:770-981-2100
Practice Address - Fax:770-808-8445
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN069143363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner