Healthcare Provider Details

I. General information

NPI: 1508676461
Provider Name (Legal Business Name): IMMANI MAYS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 LAWRENCEVILLE HWY NW
LILBURN GA
30047-3013
US

IV. Provider business mailing address

957 MAIN ST STE A #390
STONE MOUNTAIN GA
30083
US

V. Phone/Fax

Practice location:
  • Phone: 770-559-3501
  • Fax:
Mailing address:
  • Phone: 941-592-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN275877
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: