Provider Demographics
NPI:1083413827
Name:FAVORS, DEIDRA C (FNP)
Entity type:Individual
Prefix:
First Name:DEIDRA
Middle Name:C
Last Name:FAVORS
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11158 KNOTTY PINE PL
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-3294
Mailing Address - Country:US
Mailing Address - Phone:678-557-7674
Mailing Address - Fax:678-557-7674
Practice Address - Street 1:11158 KNOTTY PINE PL
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-3294
Practice Address - Country:US
Practice Address - Phone:678-557-7674
Practice Address - Fax:678-557-7674
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program