Healthcare Provider Details

I. General information

NPI: 1366592115
Provider Name (Legal Business Name): MAUREEN DEVANEY NEJEDLY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 SHALLOWFORD RD BUILDING 1300
MARIETTA GA
30062-1266
US

IV. Provider business mailing address

3225 SHALLOWFORD RD BUILDING 1300
MARIETTA GA
30062-1266
US

V. Phone/Fax

Practice location:
  • Phone: 678-560-7160
  • Fax: 678-560-7185
Mailing address:
  • Phone: 678-560-7160
  • Fax: 678-560-7185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN057680
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: