Provider Demographics
NPI:1477327815
Name:VAIDYA, RIMA NITINCHANDRA (FNP)
Entity Type:Individual
Prefix:
First Name:RIMA
Middle Name:NITINCHANDRA
Last Name:VAIDYA
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 1:5400 LAKEBROOKE RUN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3497
Mailing Address - Country:US
Mailing Address - Phone:678-697-3284
Mailing Address - Fax:
Practice Address - Street 1:2536 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3227
Practice Address - Country:US
Practice Address - Phone:470-452-4948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN279904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily