Provider Demographics
NPI:1427676204
Name:NUNNALLY, ATIA MARIE LIAGHAT (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ATIA
Middle Name:MARIE LIAGHAT
Last Name:NUNNALLY
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 INDIA HOOK RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1223
Mailing Address - Country:US
Mailing Address - Phone:803-329-1500
Mailing Address - Fax:
Practice Address - Street 1:2275 INDIA HOOK RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1223
Practice Address - Country:US
Practice Address - Phone:803-329-1500
Practice Address - Fax:803-329-9697
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100876163W00000X
SC24107363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse