Healthcare Provider Details

I. General information

NPI: 1922933076
Provider Name (Legal Business Name): MARIA MORALES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 NUTMEG WAY SW
LILBURN GA
30047-4376
US

IV. Provider business mailing address

4710 NUTMEG WAY SW
LILBURN GA
30047-4376
US

V. Phone/Fax

Practice location:
  • Phone: 828-850-7383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number257160
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: