Provider Demographics
NPI:1609401140
Name:BATIE, MALIKA ANDERSON (FNP)
Entity Type:Individual
Prefix:
First Name:MALIKA
Middle Name:ANDERSON
Last Name:BATIE
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 1:1632 CLOVERDALE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31415
Mailing Address - Country:US
Mailing Address - Phone:912-441-1367
Mailing Address - Fax:
Practice Address - Street 1:1632 CLOVERDALE DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31415-7814
Practice Address - Country:US
Practice Address - Phone:912-441-1367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF09190047363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000Medicaid