Provider Demographics
NPI:1518395854
Name:RYAN, MARY KATHERINE (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:RYAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:VERDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 HOWELL MILL RD NW STE 800
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-0922
Mailing Address - Country:US
Mailing Address - Phone:404-350-9853
Mailing Address - Fax:404-477-1162
Practice Address - Street 1:775 POPLAR RD STE 310
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-8303
Practice Address - Country:US
Practice Address - Phone:770-251-2590
Practice Address - Fax:404-477-1162
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC272967363L00000X
OHCOA.15224-NP363LA2200X
GARN248115363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5007170OtherNCBON
OHCOA.15224-NPOtherCNP