Provider Demographics
NPI:1336589183
Name:PRIDE, MARY AZAR (MS, APRN, BC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:AZAR
Last Name:PRIDE
Suffix:
Gender:F
Credentials:MS, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30-B LENOX PTE. N.E.
Mailing Address - Street 2:BLDG 30 - SUITE B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324
Mailing Address - Country:US
Mailing Address - Phone:404-869-4646
Mailing Address - Fax:770-973-6695
Practice Address - Street 1:30-B LENOX PTE. N.E.
Practice Address - Street 2:BLDG 30 - SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324
Practice Address - Country:US
Practice Address - Phone:404-869-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN43252163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult