MRS. ENAS BASHA (NPI# 1104328095) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1104328095 |
Entity Type | Individual |
Full Name | MRS. ENAS BASHA |
Credential | NP |
Practice Address |
1412 Milstead Ave Ne Conyers GA 30012-3877 |
Mailing Address |
1371 Sonoma Dr Lawrenceville GA 30045-7833 |
Practice Telephone | 4046052800 |
Mailing Telephone | 4042520256 |
Enumeration Date | 2018-03-06 |
Last Update Date | 2020-02-19 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
217282 | GA | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
1412 MILSTEAD AVE NE |
City | CONYERS |
State | GA |
Zip Code | 30012-3877 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1033191093 | Clifford N Grossman | Radiology | 1412 Milstead Ave Ne, Conyers, GA 30012-3877 | 2005-11-16 |
1417570102 | Jonathan Stott | Registered Nurse | 1412 Milstead Ave Ne, Conyers, GA 30012-3877 | 2020-05-28 |
1104486711 | Tracie Theresa Edwards | Nurse Practitioner | 1412 Milstead Ave Ne, Conyers, GA 30012-3877 | 2019-06-17 |
1386116309 | Walker Lake Intensivist, PC | Physician Assistant | 1412 Milstead Ave Ne, Conyers, GA 30012-3877 | 2019-01-02 |
1437629342 | Walker Lake Emergency Group, PC | Physician Assistant | 1412 Milstead Ave Ne, Conyers, GA 30012-3877 | 2018-12-04 |
1003385964 | Walker Lake Physician Services, PC | Internal Medicine | 1412 Milstead Ave Ne, Conyers, GA 30012-3877 | 2018-11-20 |
1306355680 | Piedmont Rockdale Hospital Inc. | General Acute Care Hospital | 1412 Milstead Ave Ne, Conyers, GA 30012 | 2017-09-29 |
1093254658 | Taylor Zahn Yengst | Nurse Practitioner | 1412 Milstead Ave Ne, Conyers, GA 30012-3877 | 2017-02-15 |
1285186452 | Shadae Mcmillan | Podiatrist | 1412 Milstead Ave Ne, Conyers, GA 30012-3877 | 2016-11-03 |
1528414943 | Kimberly Anderson | Nurse Practitioner | 1412 Milstead Ave Ne, Conyers, GA 30012-3877 | 2016-05-05 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1578188306 | The Eye Md | Ophthalmology | 1359 Milstead Road, Suite #103, Conyers, GA 30012 | 2020-06-08 |
1043855836 | Maurvet Minto | Counselor | 1175 Green St, Conyers, Conyers, GA 30012 | 2019-11-15 |
1770054561 | Sarah Elizabeth Brooks | Physical Medicine & Rehabilitation | 1290 Milstead Ave Ne, Conyers, GA 30012 | 2018-12-06 |
1679091276 | Valorie Antoinette Jones | Counselor | 1175 Green St Se, Conyers, GA 30012 | 2017-09-02 |
1558886341 | Synergy Radiology, LLC | Radiology | 1501 Milstead Road, Suite 140, Conyers, GA 30012 | 2017-08-14 |
1558813295 | Salon Lyon, LLC | Specialist | 1112 West Ave, Se, B, Conyers, GA 30012 | 2016-10-28 |
1992252753 | Traci Hunter Bryan | Pharmacist | 1501 Milstead Ave Ne, Suite 110, Conyers, GA 30012 | 2016-09-08 |
1316491830 | Hye Rim Kim | Anesthesiologist Assistant | 1380 Milstead Rd Ne, Suite G, Conyers, GA 30012 | 2016-08-12 |
1235591397 | David Jeffrey Wasserman | Optometrist | 1192 Dogwood Dr Sw, Conyers, GA 30012 | 2016-03-28 |
1174919187 | Anique Archer | Health Educator | 2170 Lester Rd Nw, Conyers, GA 30012 | 2015-04-07 |
Find all providers in zip 30012 |
Taxonomy Code | 363LA2100X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Acute Care |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1891301164 | Tashoy Wallace | Nurse Practitioner | 121 Odyssey Turn, Conyers, GA 30012-3681 | 2020-09-21 |
1720634199 | Adrienne Laquinn Kelly | Nurse Practitioner | 3281 Old Salem Rd Se, Conyers, GA 30013-2257 | 2019-08-12 |
1114273984 | Ashley Marie Grindlay | Nurse Practitioner | 1490 Milstead Rd Ne, Suite A, Conyers, GA 30012-3823 | 2012-07-31 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1265032114 | Candace Buckley | Nurse Practitioner | 244 Ashland Dr, Woodstock, GA 30189-7161 | 2020-10-29 |
1679170740 | Jennifer Lassiter | Nurse Practitioner | 4116 Holley Rd., Lizella, GA 31052 | 2020-10-02 |
1912513672 | Katherine Anne Sego | Nurse Practitioner | 4060 Rolling Meadows Ln, Watkinsville, GA 30677-3011 | 2020-09-18 |
1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
1588276505 | Sherron Johnson | Nurse Practitioner | 1980 Wrights Way, Jonesboro, GA 30236-7205 | 2020-08-20 |
1942811682 | Ashlee Renee Mack | Nurse Practitioner | 116 Slate Cir, Savannah, GA 31419-9681 | 2020-08-16 |
1467063610 | Rosa Maria Phillips | Nurse Practitioner | 649 Amicalola Woods Rd, Dawsonville, GA 30534-1205 | 2020-08-12 |
1508476581 | Jarvis Reese | Nurse Practitioner | 413 Tug Ct, Warner Robins, GA 31088-2134 | 2020-08-05 |
1750991790 | Akosua Frema Sarfo | Nurse Practitioner | 116 Ginkgo Ln, Grovetown, GA 30813-5392 | 2020-08-04 |
1851919039 | Robert Brant | Nurse Practitioner | 20 Fairway Oaks, Waverly, GA 31565-2767 | 2020-07-14 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.