Provider Demographics
NPI:1992538540
Name:ANDERSON, BETHANY (AGACNP)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 RIVERSONG WAY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1832
Mailing Address - Country:US
Mailing Address - Phone:803-571-4648
Mailing Address - Fax:
Practice Address - Street 1:5671 PEACHTREE DUNWOODY RD STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-5003
Practice Address - Country:US
Practice Address - Phone:404-778-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN247397363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care