Provider Demographics
NPI:1003260324
Name:CVS MINUTE CLINIC
Entity Type:Organization
Organization Name:CVS MINUTE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVY
Authorized Official - Middle Name:AKUA
Authorized Official - Last Name:FENIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:678-577-9287
Mailing Address - Street 1:563 GREYHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-4618
Mailing Address - Country:US
Mailing Address - Phone:678-577-9287
Mailing Address - Fax:770-774-9837
Practice Address - Street 1:101 LEXINGTON CIR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-6845
Practice Address - Country:US
Practice Address - Phone:770-486-1639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN185101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty