Provider Demographics
NPI:1750686762
Name:GUIDRY, ANGELA MARIE (PHD, APRN, CPNP)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIE
Last Name:GUIDRY
Suffix:
Gender:F
Credentials:PHD, APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 HEATHROW DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2763
Mailing Address - Country:US
Mailing Address - Phone:678-457-1229
Mailing Address - Fax:
Practice Address - Street 1:1572 HIGHWAY 85 N STE 203
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7726
Practice Address - Country:US
Practice Address - Phone:678-457-1229
Practice Address - Fax:320-210-2011
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN091759363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics