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MS. NADINE ANGELA ENNIS P.A.C.
NPI 1962571612
Physician Assistant - Medical in Atlanta, GA

Active since November 07, 2006PECOS EnrolledAccepts Medicare Assignment
3620 MARTIN LUTHER KING JR DR SW, ATLANTA, GA 30331(404) 696-7300(404) 699-3514 Get Directions Write a Review

NPPES record last updated: September 27, 2010. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ms. Nadine Angela Ennis P.a.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. NADINE ANGELA ENNIS P.A.C. (NPI 1962571612) is an individual medical provider in Atlanta, Georgia, licensed in Georgia (004493) and active in the NPI registry since November 2006. She is enrolled in Medicare PECOS and is a graduate of Other (2001).

NPPES Registry Identity

NPI1962571612
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameMS. NADINE ANGELA ENNISCredential: P.A.C.
Location Address3620 MARTIN LUTHER KING JR DR SWAtlanta, GA 30331-3711
Mailing Address3620 Martin Luther King Jr Dr SwAtlanta, GA 30331-3711 · (404) 696-7300 · Fax (404) 699-3514
Phone(404) 696-7300
Fax(404) 699-3514
Sole ProprietorNo
Medical School CMSOtherGraduated 2001
Enumeration DateNovember 7, 2006
Last NPPES UpdateSeptember 27, 2010
✔ NPI 1962571612 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in GA · 004493
3620 MARTIN LUTHER KING JR DR SW, Atlanta, GA 30331
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Other Identifiers 7

Medicare UPINQ74791GA
Medicaid457877647BGA
Medicaid457877647DGA
Medicaid457877647AGA
Medicaid457877647CGA
Medicaid457877647EGA
Medicare PIN97WCJPSGA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Ms. Nadine Angela Ennis P.a.c. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3072515832
PECOS Enrollment IDI20070207000190
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MICHEL BRATHWAITE MD
Internal Medicine (Nephrology)
3620 MARTIN LUTHER KING JR DR SW
ATLANTA, GA 30331
Fulton County (404) 696-7300
YOMARIS FIGUEROA RAMIREZ RDN, LDN, RYT
Dietitian, Registered
3620 MARTIN LUTHER KING JR DR SW
ATLANTA, GA 30331
Fulton County (404) 696-7300
ROSELINE OTUNGA FNP
Nurse Practitioner (Family)
3620 MARTIN LUTHER KING JR DR SW
ATLANTA, GA 30331
Fulton County (404) 696-7300
SOUTHWEST ATLANTA DIALYSIS CENTERS LLC
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
3620 MARTIN LUTHER KING JR DR SW
ATLANTA, GA 30331
Fulton County (404) 696-7303
NICOLE M BROWN PA-C
Physician Assistant (Medical)
3620 MARTIN LUTHER KING JR DR SW
ATLANTA, GA 30331
Fulton County (404) 696-7300

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nadine Ennis's NPI number?

The NPI number for Nadine Ennis is 1962571612. It was assigned to this individual provider in the NPPES registry on November 7, 2006.

Where is Nadine Ennis located?

Nadine Ennis practices at 3620 Martin Luther King Jr Dr SW, Atlanta, GA 30331. The listed phone number is (404) 696-7300.

What is Nadine Ennis's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Nadine Ennis enrolled in Medicare?

Yes. Nadine Ennis is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Nadine Ennis was last updated on September 27, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.