Healthcare Provider Details

I. General information

NPI: 1205100732
Provider Name (Legal Business Name): HOPE BIRDSONG RN, CNOR, RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 GLENGARRY CHASE
COVINGTON GA
30014-8946
US

IV. Provider business mailing address

335 GLENGARRY CHASE
COVINGTON GA
30014-8946
US

V. Phone/Fax

Practice location:
  • Phone: 404-783-8089
  • Fax:
Mailing address:
  • Phone: 404-783-8089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN208635
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: