Provider Demographics
NPI:1588792014
Name:ROY, ANDRE J (RN,NP)
Entity type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:J
Last Name:ROY
Suffix:
Gender:F
Credentials:RN,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:59 EXECUTIVE PARK SOUTH NE
Mailing Address - Street 2:SUITE 2085
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2208
Mailing Address - Country:US
Mailing Address - Phone:404-778-6283
Mailing Address - Fax:404-778-7208
Practice Address - Street 1:59 EXECUTIVE PARK SOUTH NE
Practice Address - Street 2:SUITE 2085
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2208
Practice Address - Country:US
Practice Address - Phone:404-778-6283
Practice Address - Fax:404-778-7208
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN140214NP363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAA20073Medicare UPIN