Provider Demographics
NPI:1265805709
Name:ANDERSON-GREENLAND, NADINE (NP-C, PMHNP)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:ANDERSON-GREENLAND
Suffix:
Gender:F
Credentials:NP-C, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 DEKALB MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4996
Mailing Address - Country:US
Mailing Address - Phone:404-501-8000
Mailing Address - Fax:
Practice Address - Street 1:879 BRAMBLE WAY
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-4282
Practice Address - Country:US
Practice Address - Phone:404-729-9859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN168657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily