Healthcare Provider Details

I. General information

NPI: 1164065884
Provider Name (Legal Business Name): HUGH GEORGE MAXWELL JR. MSN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 CASCADE RD SW STE 340
ATLANTA GA
30331-8519
US

IV. Provider business mailing address

2 OATGRASS DR
GRAYSON GA
30017-4355
US

V. Phone/Fax

Practice location:
  • Phone: 404-564-7749
  • Fax:
Mailing address:
  • Phone: 770-513-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN260086
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN260086
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: