Provider Demographics
NPI:1538950217
Name:NELSON, AYANA CYKIA
Entity type:Individual
Prefix:
First Name:AYANA
Middle Name:CYKIA
Last Name:NELSON
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 1:957 POPLAR SPRINGS RD APT 1H
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-1659
Mailing Address - Country:US
Mailing Address - Phone:404-858-7617
Mailing Address - Fax:
Practice Address - Street 1:957 POPLAR SPRINGS RD APT 1H
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-1659
Practice Address - Country:US
Practice Address - Phone:404-858-7617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHCP042949251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health