Provider Demographics
NPI:1902322902
Name:CUNNINGHAM, SYDNEY JANAI (PMHNP)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:JANAI
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 COOL SPRINGS DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5059
Mailing Address - Country:US
Mailing Address - Phone:678-282-7496
Mailing Address - Fax:
Practice Address - Street 1:11111 HOUZE RD STE 225
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5618
Practice Address - Country:US
Practice Address - Phone:770-603-0123
Practice Address - Fax:770-910-9919
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239010363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily