Basic Information
| Provider Information | |||||||||
| NPI: | 1881159192 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KORJENIC | ||||||||
| FirstName: | SYLVIA | ||||||||
| MiddleName: | DIANA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9128 CARROLL MANOR DR | ||||||||
| Address2: | |||||||||
| City: | SANDY SPRINGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303502012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042181445 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5665 PEACHTREE DUNWOODY RD | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788437001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2019 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN210452 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.