Healthcare Provider Details

I. General information

NPI: 1912997206
Provider Name (Legal Business Name): DELLA LERTPENMAETA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 12/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 BROWNSVILLE RD
POWDER SPRINGS GA
30127-2559
US

IV. Provider business mailing address

4250 BROWNSVILLE RD
POWDER SPRINGS GA
30127-2559
US

V. Phone/Fax

Practice location:
  • Phone: 678-567-8000
  • Fax: 770-439-3555
Mailing address:
  • Phone: 770-920-2280
  • Fax: 770-439-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN093485
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: