Provider Demographics
NPI:1992583801
Name:ATCHISON, MYRA RONETTE (FNP-BC)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:RONETTE
Last Name:ATCHISON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 GREEN TREE CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-5097
Mailing Address - Country:US
Mailing Address - Phone:678-334-6467
Mailing Address - Fax:
Practice Address - Street 1:2121 SALEM RD SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1823
Practice Address - Country:US
Practice Address - Phone:770-679-4360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN283606261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care