Healthcare Provider Details

I. General information

NPI: 1619682093
Provider Name (Legal Business Name): LORRAINE HARDY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORRAINE RUFARO HARDY NP

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 POPLAR RD
NEWNAN GA
30265-1618
US

IV. Provider business mailing address

1555 WALKING HORSE TRL
CUMMING GA
30041-8157
US

V. Phone/Fax

Practice location:
  • Phone: 404-367-3014
  • Fax:
Mailing address:
  • Phone: 470-725-0535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number190058
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2022008453
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: