Provider Demographics
NPI:1336694595
Name:EMMANUEL, ROSELANDE (NP)
Entity Type:Individual
Prefix:MISS
First Name:ROSELANDE
Middle Name:
Last Name:EMMANUEL
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 1:3424 SARDIS BEND DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-6027
Mailing Address - Country:US
Mailing Address - Phone:678-677-0707
Mailing Address - Fax:
Practice Address - Street 1:1990 OLD PARKER RD SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6239
Practice Address - Country:US
Practice Address - Phone:678-374-2959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily