Provider Demographics
NPI:1326105792
Name:MRAZ, NORMA RIVERA (AUD)
Entity Type:Individual
Prefix:DR
First Name:NORMA
Middle Name:RIVERA
Last Name:MRAZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 PLANTATION RIDGE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9178
Mailing Address - Country:US
Mailing Address - Phone:704-775-0416
Mailing Address - Fax:
Practice Address - Street 1:3400 OLD MILTON PKWY STE C385
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4428
Practice Address - Country:US
Practice Address - Phone:770-653-7027
Practice Address - Fax:770-343-5190
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA231H00000X
GAAUD003473231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA318694198AMedicaid
GA511I640020Medicare UPIN