Mariamma Vijai
Individual provider Active NPI Family Nurse Practitioner · Lawrenceville, GA
NPI 1437898293 · NPPES record last updated May 31, 2022
Key facts
- NPI
- 1437898293
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN173679 (GA)
- Practice address
- 1000 Medical Center Blvd
Lawrenceville, GA 30046-7694 - Phone
- (678) 312-3460
- NPI assigned
- May 31, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220627001012 | GA | Practitioner - Nurse Practitioner | 1658750302 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN173679 | GA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Atlanta Anesthesia Professionals, LLC | Current |
Accepting new patients | |
| North Atlanta Professional Services LLC | Current |
Accepting new patients |
Locations
1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356
1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737
1000 Johnson Fy Rd NE
Sandy Springs, GA 30342
Phone (404) 851-1000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN173679 | GA | Yes |
Addresses
Primary practice location
1000 Medical Center Blvd
Lawrenceville, GA 30046-7694
Mailing address
1000 Medical Center Blvd
Lawrenceville, GA 30046-7694
Phone (678) 312-2394
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | mariamma.vijai@northside.com |
Other providers in Lawrenceville, GA
- View Point Health
- View Point Health
- View Point Health
- View Point Health- Lawrenceveille Center
- J Vincent Vigil
- Isabelle Fulai Vikumitsi
- Village Community Services
- Village Life,LLC
- Village Podiatry Group, LLC
- Village Podiatry Group, LLC.
All providers in Lawrenceville, GA · Family Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.