Healthcare Provider Details

I. General information

NPI: 1083783021
Provider Name (Legal Business Name): DEBORAH COLLINS PIETRANGELO FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH JEAN SMITH FNPC

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 RIVERSTONE VIS STE 215
BLUE RIDGE GA
30513-6665
US

IV. Provider business mailing address

101 RIVERSTONE VIS STE 215
BLUE RIDGE GA
30513-6665
US

V. Phone/Fax

Practice location:
  • Phone: 706-946-4227
  • Fax: 706-258-4715
Mailing address:
  • Phone: 706-946-4227
  • Fax: 706-258-4715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN181932
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: