Healthcare Provider Details

I. General information

NPI: 1316757388
Provider Name (Legal Business Name): EMILY FAYE BREAULT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY FAYE HENDRICKS

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 BETHELVIEW RD STE 500A
CUMMING GA
30040-7530
US

IV. Provider business mailing address

5610 BETHELVIEW RD STE 500A
CUMMING GA
30040-7530
US

V. Phone/Fax

Practice location:
  • Phone: 678-821-5376
  • Fax:
Mailing address:
  • Phone: 678-821-5376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN311460
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: