Provider Demographics
NPI:1174174171
Name:BARTOLI, MONIKA
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:BARTOLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 NORTEC DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-5835
Mailing Address - Country:US
Mailing Address - Phone:678-374-7514
Mailing Address - Fax:678-374-7517
Practice Address - Street 1:1101 NORTEC DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5835
Practice Address - Country:US
Practice Address - Phone:678-374-7514
Practice Address - Fax:678-374-7517
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily