Healthcare Provider Details

I. General information

NPI: 1558567271
Provider Name (Legal Business Name): CAROL BRADLEY HESS RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL HARBIN BRADLEY HESS

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 JOHNSON FERRY RD SUITE 150
MARIETTA GA
30068-5425
US

IV. Provider business mailing address

6285 BARFIELD RD NE SUITE 250
ATLANTA GA
30328-4303
US

V. Phone/Fax

Practice location:
  • Phone: 770-977-1510
  • Fax: 770-509-8858
Mailing address:
  • Phone: 404-303-1224
  • Fax: 404-303-1325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN47225 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: