Provider Demographics
NPI:1194250043
Name:PEREZ, ANISHA (CD(DTI))
Entity type:Individual
Prefix:
First Name:ANISHA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CD(DTI)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 LYMAN WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-8697
Mailing Address - Country:US
Mailing Address - Phone:678-769-6139
Mailing Address - Fax:
Practice Address - Street 1:1600 WOODLAND WAY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2080
Practice Address - Country:US
Practice Address - Phone:678-769-6139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula