Provider Demographics
NPI:1932306099
Name:NAGADDYA, LILLIAN MARIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:MARIA
Last Name:NAGADDYA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 CLEVELAND AVE
Mailing Address - Street 2:SUITE 2-D
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3417
Mailing Address - Country:US
Mailing Address - Phone:404-684-7111
Mailing Address - Fax:404-684-7112
Practice Address - Street 1:1203 CLEVELAND AVE
Practice Address - Street 2:SUITE 2-D
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3417
Practice Address - Country:US
Practice Address - Phone:404-684-7111
Practice Address - Fax:404-684-7112
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN143664163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN143664OtherRN LICENSE
06081973OtherBIRTH DATE