Healthcare Provider Details

I. General information

NPI: 1497686976
Provider Name (Legal Business Name): MAURICE MCCORMICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 W DRUID HILLS DR NE
BROOKHAVEN GA
30329-2121
US

IV. Provider business mailing address

3450 ROXBORO RD NE APT 5406
ATLANTA GA
30326-1793
US

V. Phone/Fax

Practice location:
  • Phone: 404-800-9447
  • Fax:
Mailing address:
  • Phone: 601-307-4301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP715040
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: