Healthcare Provider Details

I. General information

NPI: 1497387633
Provider Name (Legal Business Name): MARGARET BRONAUGH SPORN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEG SPORN NP

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date: 02/07/2020
Reactivation Date: 02/19/2020

III. Provider practice location address

95 COLLIER RD NW STE 5015
ATLANTA GA
30309-1721
US

IV. Provider business mailing address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-6517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN258801
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN258801
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN258801
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: