Provider Demographics
NPI:1700506144
Name:DANO, MALIKATA NICOLETTE (NP)
Entity Type:Individual
Prefix:
First Name:MALIKATA
Middle Name:NICOLETTE
Last Name:DANO
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 1:5778 WEMBLEY DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1875
Mailing Address - Country:US
Mailing Address - Phone:404-852-1333
Mailing Address - Fax:
Practice Address - Street 1:101 QUARTZ DR STE 103B
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-3201
Practice Address - Country:US
Practice Address - Phone:770-812-3530
Practice Address - Fax:770-812-3579
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN195658363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health