MEDICARE: NADEGE LAURE PONE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN254532	GA

General Provider Information

NPI Number	:	1265179576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADEGE LAURE PONE NP

Provider Business Mailing Address
First Line	:	1841 MONTREAL RD
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-5712
Country	:	US
Telephone Number	:	770-800-2619
Fax Number	:	770-790-3443

Provider Business Practice Location Address
First Line	:	722 COLLINS HILL RD STE H-428
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-4118
Country	:	US
Telephone Number	:	770-800-2619
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	01/19/2026

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