Healthcare Provider Details

I. General information

NPI: 1538880653
Provider Name (Legal Business Name): QADARA BEYAH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 FRANKLIN GTWY SE
MARIETTA GA
30067-8705
US

IV. Provider business mailing address

1405 FRANKLIN GTWY SE
MARIETTA GA
30067-8705
US

V. Phone/Fax

Practice location:
  • Phone: 770-951-5400
  • Fax: 770-702-5627
Mailing address:
  • Phone: 770-951-5400
  • Fax: 770-702-5627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN248480
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: