Provider Demographics
NPI:1932648730
Name:NNOKP
Entity type:Organization
Organization Name:NNOKP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-732-6007
Mailing Address - Street 1:777 FRANKLIN GTWY SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-7803
Mailing Address - Country:US
Mailing Address - Phone:770-732-6007
Mailing Address - Fax:770-732-8242
Practice Address - Street 1:777 FRANKLIN GTWY SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7803
Practice Address - Country:US
Practice Address - Phone:770-732-6007
Practice Address - Fax:770-732-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000874057IMedicaid
GA000906716CMedicaid
GA000813425EMedicaid
GA000897454EMedicaid
GA003145632AMedicaid
GA818552480AMedicaid