Provider Demographics
NPI:1801839600
Name:PRYOR, ANITA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:PRYOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:GA
Mailing Address - Zip Code:30206-2101
Mailing Address - Country:US
Mailing Address - Phone:770-468-8464
Mailing Address - Fax:770-229-8464
Practice Address - Street 1:327 S. 9TH STREET
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4111
Practice Address - Country:US
Practice Address - Phone:770-233-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN102357363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBHXXMedicare ID - Type Unspecified
GAQ29558Medicare UPIN