Individual provider Active NPI

Natacha Etienne Mpile, FNP-BC

  • Gerontology Nurse Practitioner
  • Alpharetta, GA
National Provider Identifier
1538671532
Registry record updated Apr 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
RN175038 Issued in GA
Practice address
3905 Brookside Pkwy Ste 300
Alpharetta, GA 30022-4458
Phone
(770) 442-1911
NPI assigned
Oct 30, 2017
Last updated
Apr 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN175038 GA
Gerontology Nurse Practitioner 363LG0600X RN175038 GA Primary

Addresses

Primary practice location

3905 Brookside Pkwy Ste 300
Alpharetta, GA 30022-4458

Mailing address

663 Lanier Park Dr
Gainesville, GA 30501-2059
Phone (678) 904-4742

Other identifiers 2

IdentifierTypeStateIssuer
2019074541OtherGAANCC CERTIFICATION
RN175038OtherGASTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220414000965 GA Practitioner - Nurse Practitioner 8820484124 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeast Medical Group, P.C.Group PAC ID 3577559673, 139 clinicians

Practice addresses (Care Compare)

3905 Brookside Pkwy
Suite 300
Alpharetta, GA 30022-4425
Phone (770) 442-1911

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN175038GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Medical Group, P.C. CurrentSince Mar 10, 2025 Accepting new patients
Kidney Care Center of Georgia LLC CurrentSince Mar 29, 2022 Accepting new patients
Physician First Health Network PastSince Jun 3, 2025 Accepting new patients

Locations

3905 Brookside Pkwy
Ste 300
Alpharetta, GA 30022
Phone (770) 442-9111

1255 Friendship Rd
Ste 130
Braselton, GA 30517
Phone (678) 341-6350

663 Lanier Park Dr
Gainesville, GA 30501
Phone (678) 450-8841

4300 Northpoint Pkwy
Ste 300
Johns Creek, GA 30022
Phone (770) 518-4406

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DIJIBA
  • Direct secure messaging: nmpile37000@direct.acumenmd.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743984000000",
    "number": "1538671532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "663 LANIER PARK DR",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012059",
            "telephone_number": "678-904-4742",
            "fax_number": "678-971-6065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3905 BROOKSIDE PKWY STE 300",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300224458",
            "telephone_number": "770-442-1911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MPILE",
        "first_name": "NATACHA",
        "middle_name": "ETIENNE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-30",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN175038",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "GA",
            "license": "RN175038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANCC CERTIFICATION",
            "identifier": "2019074541",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "RN175038",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpharetta, GA

Sources for this page

Verify at the official NPI Registry.