Provider Demographics
NPI:1659251023
Name:FROST, MAGGIE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 BROCKETT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1479 BROCKETT RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7326
Practice Address - Country:US
Practice Address - Phone:404-625-5427
Practice Address - Fax:404-508-8944
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN269072363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health