Provider Demographics
NPI:1487632451
Name:MCBRIDE, IRENE B (MSN)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:B
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:BOGINOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1365 CLIFTON ROAD, NE
Mailing Address - Street 2:SUITE C-2094
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-1900
Mailing Address - Fax:404-778-5676
Practice Address - Street 1:1365 CLIFTON ROAD, NE
Practice Address - Street 2:SUITE C-2094
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-1900
Practice Address - Fax:404-778-5676
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN165190363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ45333Medicare UPIN
GA50BBJFKMedicare ID - Type Unspecified