Healthcare Provider Details

I. General information

NPI: 1891990297
Provider Name (Legal Business Name): DEBRA CARDIN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5456 PEACHTREE INDUSTRIAL BLVD STE 144
ATLANTA GA
30341-2235
US

IV. Provider business mailing address

PO BOX 813092
SMYRNA GA
30081-8092
US

V. Phone/Fax

Practice location:
  • Phone: 770-985-4257
  • Fax: 770-985-4258
Mailing address:
  • Phone: 770-985-4257
  • Fax: 770-985-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN032793
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: