Basic Information
| Provider Information | |||||||||
| NPI: | 1487927588 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LERMA | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | PNP-AC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 JOHNSON FY RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047855437 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1001 JOHNSON FY RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047855437 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2012 | ||||||||
| LastUpdateDate: | 09/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0222X | NCO-000006 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics, Critical Care |
ID Information
| ID | Type | State | Issuer | Description | 209.009364 | 01 | IL | IL LICENSE NUMBER | OTHER | 256427 | 01 | GA | GEORGIA RN LICENSE | OTHER | NCO-000006 | 01 | GA | GEORGIA APN LICENSE | OTHER |