Provider Demographics
NPI:1194550632
Name:KOREDIJAN, ERIKA (NP)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:KOREDIJAN
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 1:5400 LAUREL SPRINGS PKWY STE 1404
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6098
Mailing Address - Country:US
Mailing Address - Phone:678-347-2153
Mailing Address - Fax:
Practice Address - Street 1:5400 LAUREL SPRINGS PKWY STE 1404
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6098
Practice Address - Country:US
Practice Address - Phone:678-347-2153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN259444363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner