Provider Demographics
NPI:1275903510
Name:RANEY, ANGELA FOREMAN (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:FOREMAN
Last Name:RANEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 CHARLES HARDY PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-5723
Mailing Address - Country:US
Mailing Address - Phone:770-445-2128
Mailing Address - Fax:
Practice Address - Street 1:495 CHARLES HARDY PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-5723
Practice Address - Country:US
Practice Address - Phone:770-445-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN151921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily