Provider Demographics
NPI:1710519251
Name:ANDERSON, NIYETROSHIA H
Entity Type:Individual
Prefix:
First Name:NIYETROSHIA
Middle Name:H
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 SYCAMORE DR APT A9
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-2940
Mailing Address - Country:US
Mailing Address - Phone:706-386-4169
Mailing Address - Fax:
Practice Address - Street 1:601 BROAD ST STE 5A
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1467
Practice Address - Country:US
Practice Address - Phone:706-294-9804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide