Provider Demographics
NPI:1669100418
Name:ACKERMAN, ALEXANDRA MARIA (NP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MARIA
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 WITCHER RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-4640
Mailing Address - Country:US
Mailing Address - Phone:262-758-1654
Mailing Address - Fax:
Practice Address - Street 1:110 OAK HILL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2313
Practice Address - Country:US
Practice Address - Phone:770-304-0987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN283458207Q00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine