Healthcare Provider Details

I. General information

NPI: 1316656366
Provider Name (Legal Business Name): HANNAH DEGRANGE FAIRLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 HOSPITAL PKWY
JOHNS CREEK GA
30097-5775
US

IV. Provider business mailing address

6325 HOSPITAL PKWY
JOHNS CREEK GA
30097-5775
US

V. Phone/Fax

Practice location:
  • Phone: 678-474-7000
  • Fax:
Mailing address:
  • Phone: 662-352-6038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP308062
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN308062
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: