Provider Demographics
NPI:1336286723
Name:HEADRICK, MOLLIE CHRISTENE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MOLLIE
Middle Name:CHRISTENE
Last Name:HEADRICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1116 OVERLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-1446
Mailing Address - Country:US
Mailing Address - Phone:770-967-1327
Mailing Address - Fax:
Practice Address - Street 1:1990 LAKESIDE PKWY STE 170
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5883
Practice Address - Country:US
Practice Address - Phone:770-938-1757
Practice Address - Fax:770-938-1759
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN134270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily