Provider Demographics
NPI:1346630662
Name:ANUFORO, SYLVANUS AMANZE (APRN FNP-C DNP)
Entity Type:Individual
Prefix:
First Name:SYLVANUS
Middle Name:AMANZE
Last Name:ANUFORO
Suffix:
Gender:M
Credentials:APRN FNP-C DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MERCHANTS SQ
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-5029
Mailing Address - Country:US
Mailing Address - Phone:404-717-7014
Mailing Address - Fax:678-653-8224
Practice Address - Street 1:280 MERCHANTS SQ
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-5029
Practice Address - Country:US
Practice Address - Phone:404-717-7014
Practice Address - Fax:770-577-3162
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-24
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN175316163WH0200X, 363LF0000X
CA95005802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN175316OtherGEORGIA BOARD OF NURSING
GA003151263AMedicaid