Healthcare Provider Details

I. General information

NPI: 1659192995
Provider Name (Legal Business Name): MARIE YVES PIQUANT MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5126 HOSPITAL DR NE
COVINGTON GA
30014-2566
US

IV. Provider business mailing address

1017 HERB CT
MCDONOUGH GA
30252-4166
US

V. Phone/Fax

Practice location:
  • Phone: 678-763-6650
  • Fax:
Mailing address:
  • Phone: 678-763-6650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN246077
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024084324
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: