Healthcare Provider Details

I. General information

NPI: 1982988028
Provider Name (Legal Business Name): HERRETTA LACHELL PICKENS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7028 HIGHWAY 85
RIVERDALE GA
30274-2946
US

IV. Provider business mailing address

PO BOX 740015
ATLANTA GA
30374-0015
US

V. Phone/Fax

Practice location:
  • Phone: 470-444-3136
  • Fax: 470-298-7730
Mailing address:
  • Phone: 833-804-1695
  • Fax: 312-929-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN-NP137164
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: