Organization · Type 2 NPI
Nurse Practioner
Community Health Clinic/Center · Kennesaw, GA
NPI number
1629519202
Active
Practice location
4044 George Busbee Pkwy NW Apt 4207
Kennesaw, GA 30144-6890
Mailing address
PO Box 1234
Powder Springs, GA 30127-7234
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Community Health Clinic/Center Primary | 261QC1500X | 193760 (GA) |
| Point of Service | 305S00000X | 193760 (GA) |
Community Health Clinic/Center: Definition to come...
About NPI 1629519202
Nurse Practioner's National Provider Identifier is 1629519202, issued on Mar 15, 2017. The primary taxonomy on file is Community Health Clinic/Center (261QC1500X), and the practice location is in Kennesaw, GA. The record was last updated on Mar 15, 2017.