Provider Demographics
NPI:1194811174
Name:HERMIDA, ADRIANA P (MD)
Entity type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:P
Last Name:HERMIDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 FIELDSTONE PKWY
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-7500
Mailing Address - Country:US
Mailing Address - Phone:678-489-3403
Mailing Address - Fax:
Practice Address - Street 1:826 FIELDSTONE PKWY
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-7500
Practice Address - Country:US
Practice Address - Phone:678-489-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0590742084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA0113Medicare UPIN