Provider Demographics
NPI:1639883556
Name:MURPHY, EBONI PATICE (FNP)
Entity Type:Individual
Prefix:
First Name:EBONI
Middle Name:PATICE
Last Name:MURPHY
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 1:6985 SMOKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-3131
Mailing Address - Country:US
Mailing Address - Phone:404-247-6800
Mailing Address - Fax:
Practice Address - Street 1:2996 GRANDVIEW AVE NE STE 224
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3245
Practice Address - Country:US
Practice Address - Phone:404-960-0812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN282243363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner