Provider Demographics
NPI:1497588693
Name:NAGANOMA, NAOMI (PA-C)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:NAGANOMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 RONALD REAGAN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6092
Mailing Address - Country:US
Mailing Address - Phone:404-994-4561
Mailing Address - Fax:
Practice Address - Street 1:2870 RONALD REAGAN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6092
Practice Address - Country:US
Practice Address - Phone:404-994-4561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
GA12593363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical