Provider Demographics
NPI:1801439401
Name:MONDAL, DEBADRITA (FNP-BC)
Entity type:Individual
Prefix:
First Name:DEBADRITA
Middle Name:
Last Name:MONDAL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3699 CASCADE RD SW STE B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2164
Mailing Address - Country:US
Mailing Address - Phone:404-691-7006
Mailing Address - Fax:
Practice Address - Street 1:3699 CASCADE RD SW STE B2
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2163
Practice Address - Country:US
Practice Address - Phone:404-691-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-26
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA289609363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily