Provider Demographics
NPI:1881211233
Name:MAYETA-PEART, ADELAIDA LARDUET (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:ADELAIDA
Middle Name:LARDUET
Last Name:MAYETA-PEART
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 JODECO RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8297
Mailing Address - Country:US
Mailing Address - Phone:770-898-7840
Mailing Address - Fax:770-898-7960
Practice Address - Street 1:1301 SIGMAN RD NE STE 230
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3819
Practice Address - Country:US
Practice Address - Phone:678-609-4912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN242101363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty