Healthcare Provider Details

I. General information

NPI: 1760463517
Provider Name (Legal Business Name): KAREN BELINDA IVEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3999 AUSTELL RD STE 901
AUSTELL GA
30106-1160
US

IV. Provider business mailing address

3350 RIVERWOOD PKWY SE STE 1850
ATLANTA GA
30339-3300
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 770-809-3036
  • Fax: 404-662-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN106643
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: