Organization · Type 2 NPI
Clinica Agave Clinic
Family Nurse Practitioner · Forest Park, GA
NPI number
1407091705
Active
Practice location
4434 Jonesboro Rd
Forest Park, GA 30297-4313
Fax (404) 377-3445
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner Primary | 363LF0000X | None listed |
Family Nurse Practitioner: Definition to come...
Other family nurse practitioner providers in Forest Park
About NPI 1407091705
Clinica Agave Clinic's National Provider Identifier is 1407091705, issued on Dec 16, 2008. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Forest Park, GA. The record was last updated on Dec 16, 2008.