Provider Demographics
NPI:1467046649
Name:NASRALLAH, MAREDITH CLOSE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MAREDITH
Middle Name:CLOSE
Last Name:NASRALLAH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2386 HUNTING VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4226
Mailing Address - Country:US
Mailing Address - Phone:914-420-7038
Mailing Address - Fax:
Practice Address - Street 1:95 COLLIER RD NW STE 4075
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1751
Practice Address - Country:US
Practice Address - Phone:404-355-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN253722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily