Healthcare Provider Details

I. General information

NPI: 1134285497
Provider Name (Legal Business Name): DEBORAH RUTH MCNAIR ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 OLD SUWANEE RD
SUWANEE GA
30024-7014
US

IV. Provider business mailing address

3780 OLD SUWANEE RD
SUWANEE GA
30024-7014
US

V. Phone/Fax

Practice location:
  • Phone: 678-925-8801
  • Fax:
Mailing address:
  • Phone: 678-925-8801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number189661
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number189661
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP340150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: