Healthcare Provider Details

I. General information

NPI: 1275426793
Provider Name (Legal Business Name): AUDREY URQUHART FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 DIXIE ST STE 200
CARROLLTON GA
30117-3889
US

IV. Provider business mailing address

706 DIXIE ST STE 200
CARROLLTON GA
30117-3889
US

V. Phone/Fax

Practice location:
  • Phone: 770-214-2229
  • Fax: 770-214-9691
Mailing address:
  • Phone: 770-214-2229
  • Fax: 770-214-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP238707
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: