Provider Demographics
NPI:1619203635
Name:GARDNER, ALANA (CNP)
Entity Type:Individual
Prefix:
First Name:ALANA
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD STE 4203
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4540
Mailing Address - Country:US
Mailing Address - Phone:770-831-3018
Mailing Address - Fax:770-831-3669
Practice Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD STE 4203
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4540
Practice Address - Country:US
Practice Address - Phone:770-831-3018
Practice Address - Fax:770-831-3669
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN225359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4030006Medicaid
NP32711Medicare PIN