Provider Demographics
NPI:1134618309
Name:STYLES, AJA MONIQUE (LPN)
Entity type:Individual
Prefix:
First Name:AJA
Middle Name:MONIQUE
Last Name:STYLES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 STATION CLUB DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7520
Mailing Address - Country:US
Mailing Address - Phone:678-619-6925
Mailing Address - Fax:
Practice Address - Street 1:2702 STATION CLUB DR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7520
Practice Address - Country:US
Practice Address - Phone:678-908-7697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN085567164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse