Provider Demographics
NPI:1710489018
Name:DENNIN, ERIC ANDREW (APRN)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ANDREW
Last Name:DENNIN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 BRIARCLIFF RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2647
Mailing Address - Country:US
Mailing Address - Phone:678-603-3765
Mailing Address - Fax:
Practice Address - Street 1:1365 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5029
Practice Address - Country:US
Practice Address - Phone:678-603-3765
Practice Address - Fax:770-506-4580
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225712363LF0000X
GARN225712363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily