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MS. NADINE ANGELA ENNIS P.A.C. NPI 1962571612


NPI Information

NPI: 1962571612
Provider Name: MS. NADINE ANGELA ENNIS, P.A.C.
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
3620 MARTIN LUTHER KING JR DR SW
ATLANTA, GA
ZIP 30331
Phone: (404) 696-7300
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MS. Nadine Angela Ennis, P.A.C. is a medical physician assistant in Atlanta, GA with 23 years of experience. MS. Nadine Angela Ennis, P.A.C. NPI is 1962571612. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3620 MARTIN LUTHER KING JR DR SW
ATLANTA, GA
ZIP 30331-711
Phone: (404) 696-7300
Fax: (404) 699-3514

The NPI 1962571612 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Dialysis services (4 or more physician visits per month), patient 20 years of age and older (HCPCS:90960)
  • Dialysis services (2-3 physician visits per month), patient 20 years of age and older (HCPCS:90961)

The enumeration date for this NPI number is 11/7/2006 and was last updated on 9/27/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363AM0700XPhysician AssistantMedical004493GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1Q74791MEDICARE UPINGEORGIA
2457877647BMEDICAIDGEORGIA
3457877647DMEDICAIDGEORGIA
4457877647AMEDICAIDGEORGIA
5457877647CMEDICAIDGEORGIA
6457877647EMEDICAIDGEORGIA
797WCJPSMEDICARE PINGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.