Provider Demographics
NPI:1134460207
Name:HOOPER, GANIELLE (NP)
Entity type:Individual
Prefix:DR
First Name:GANIELLE
Middle Name:
Last Name:HOOPER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:GANIELLE
Other - Middle Name:
Other - Last Name:CHAPPELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1015 WYNMONT DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4934
Mailing Address - Country:US
Mailing Address - Phone:301-385-3438
Mailing Address - Fax:
Practice Address - Street 1:2551 ROSWELL RD STE 420
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4761
Practice Address - Country:US
Practice Address - Phone:678-648-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20171710363LP0808X
GARN271087363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty