Provider Demographics
NPI:1700266517
Name:NAKANDE, MARIE (CNM, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:NAKANDE
Suffix:
Gender:F
Credentials:CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 NASH CIR SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-5133
Mailing Address - Country:US
Mailing Address - Phone:678-464-0722
Mailing Address - Fax:
Practice Address - Street 1:6095 PROFESSIONAL PKWY STE A210
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5611
Practice Address - Country:US
Practice Address - Phone:770-949-4188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127872363LW0102X, 367A00000X
GARN192379367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health