Healthcare Provider Details

I. General information

NPI: 1134941909
Provider Name (Legal Business Name): MAURA HEATH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 OLD HIGHWAY 5 STE 103
BLUE RIDGE GA
30513-6239
US

IV. Provider business mailing address

1720 WINDWARD CONCOURSE
ALPHARETTA GA
30005-2291
US

V. Phone/Fax

Practice location:
  • Phone: 678-513-2273
  • Fax: 678-513-8869
Mailing address:
  • Phone: 678-513-2273
  • Fax: 678-513-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN292929
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: