Provider Demographics
NPI:1689878795
Name:DAMERON, ANDREA (CFNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:DAMERON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5669 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:STE 210
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1786
Mailing Address - Country:US
Mailing Address - Phone:404-255-4333
Mailing Address - Fax:404-255-0601
Practice Address - Street 1:5669 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:STE 210
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1786
Practice Address - Country:US
Practice Address - Phone:404-255-4333
Practice Address - Fax:404-255-0601
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA134732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily