Provider Demographics
NPI:1407586688
Name:AKINS, FANTOYA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:FANTOYA
Middle Name:
Last Name:AKINS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:FANTOYA
Other - Middle Name:
Other - Last Name:AKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1808 WANDA WAY
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-1087
Mailing Address - Country:US
Mailing Address - Phone:205-545-1938
Mailing Address - Fax:
Practice Address - Street 1:700 OLD ROSWELL LAKES PKWY
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1693
Practice Address - Country:US
Practice Address - Phone:800-803-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN261520163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy