Provider Demographics
NPI:1366970139
Name:ERAWOC, KORPO KPISSAY (MSN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KORPO
Middle Name:KPISSAY
Last Name:ERAWOC
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 MILL POINTE CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-9111
Mailing Address - Country:US
Mailing Address - Phone:404-447-7927
Mailing Address - Fax:
Practice Address - Street 1:201 JORDAN RD STE 100
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-4495
Practice Address - Country:US
Practice Address - Phone:678-230-1818
Practice Address - Fax:877-319-4345
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN175153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily