Provider Demographics
NPI:1689787533
Name:ROYAL, LINDA (RN, FNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:ROYAL
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1028460
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-0001
Mailing Address - Country:US
Mailing Address - Phone:404-501-7969
Mailing Address - Fax:404-501-6638
Practice Address - Street 1:2665 N DECATUR RD
Practice Address - Street 2:SUITE 255
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6149
Practice Address - Country:US
Practice Address - Phone:404-501-2927
Practice Address - Fax:404-501-7644
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA077505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA456100341BMedicaid
GA456100341AMedicaid
GA50BBKPNMedicare PIN