Healthcare Provider Details

I. General information

NPI: 1184317463
Provider Name (Legal Business Name): BRENDA ALICIA NARVAEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 DAWSON BLVD STE I
NORCROSS GA
30093-1259
US

IV. Provider business mailing address

670 DICKENS RD NW
LILBURN GA
30047-5839
US

V. Phone/Fax

Practice location:
  • Phone: 770-662-0249
  • Fax:
Mailing address:
  • Phone: 678-510-6560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: