Provider Demographics
NPI:1598224081
Name:ANU, JOICE ATEM
Entity Type:Individual
Prefix:
First Name:JOICE
Middle Name:ATEM
Last Name:ANU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 CHARLES HARDY PKWY STE 122
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-3317
Mailing Address - Country:US
Mailing Address - Phone:404-933-2641
Mailing Address - Fax:
Practice Address - Street 1:4075 CHARLES HARDY PKWY STE 122
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-3317
Practice Address - Country:US
Practice Address - Phone:404-933-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA226765163W00000X
261QH0100X
GARN226765363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service