Provider Demographics
NPI:1619271442
Name:KUMAR, SERENA (MSN, ANP-BC)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MSN, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PARKBROOKE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-6331
Mailing Address - Country:US
Mailing Address - Phone:678-888-0332
Mailing Address - Fax:
Practice Address - Street 1:200 PARKBROOKE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6331
Practice Address - Country:US
Practice Address - Phone:678-888-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN193069 NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health