Healthcare Provider Details

I. General information

NPI: 1437134483
Provider Name (Legal Business Name): NANCI BRINN AHEARN F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 INTERCHANGE DR
RICHMOND HILL GA
31324-7661
US

IV. Provider business mailing address

89 INTERCHANGE DR
RICHMOND HILL GA
31324-7661
US

V. Phone/Fax

Practice location:
  • Phone: 912-527-5301
  • Fax: 912-756-4740
Mailing address:
  • Phone: 912-527-5301
  • Fax: 912-756-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number200100698
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: