Healthcare Provider Details

I. General information

NPI: 1831073857
Provider Name (Legal Business Name): KATHRYN MAHONEY HANCOCK FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 LANIER 400 PKWY # A
CUMMING GA
30040-2539
US

IV. Provider business mailing address

2810 BURGUNDY DR
CUMMING GA
30041-8031
US

V. Phone/Fax

Practice location:
  • Phone: 770-205-1294
  • Fax:
Mailing address:
  • Phone: 770-845-7446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number005359
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: