Healthcare Provider Details

I. General information

NPI: 1336589183
Provider Name (Legal Business Name): MARY AZAR PRIDE MS., A.P.R.N., B.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30-B LENOX PTE. N.E. BLDG 30 - SUITE B
ATLANTA GA
30324
US

IV. Provider business mailing address

30-B LENOX PTE. N.E. BLDG 30 - SUITE B
ATLANTA GA
30324
US

V. Phone/Fax

Practice location:
  • Phone: 404-869-4646
  • Fax:
Mailing address:
  • Phone: 404-869-4646
  • Fax: 770-973-6695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN43252
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: