Provider Demographics
NPI:1659948255
Name:GIVENS, DEANNA MICHELLE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MICHELLE
Last Name:GIVENS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PALADIAN WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:AL
Mailing Address - Zip Code:36856-2814
Mailing Address - Country:US
Mailing Address - Phone:334-320-9110
Mailing Address - Fax:
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:334-320-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN280052363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care