=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336944768
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA JOSE LOPES DNP, CPNP-PC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2025
-----------------------------------------------------
Last Update Date | 02/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3780 HOLCOMB BRIDGE RD
-----------------------------------------------------
City | NORCROSS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30092-4855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-263-9101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3561 LYNLEY MILL LN
-----------------------------------------------------
City | DACULA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30019-5054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-949-7840
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | RN316810
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------