Provider Demographics
NPI:1003697103
Name:PERRYMAN, COURTNAY KELLY (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:COURTNAY
Middle Name:KELLY
Last Name:PERRYMAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11731 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:PAVO
Mailing Address - State:GA
Mailing Address - Zip Code:31778-3958
Mailing Address - Country:US
Mailing Address - Phone:229-403-4868
Mailing Address - Fax:
Practice Address - Street 1:1102 SMITH AVE STE K
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5740
Practice Address - Country:US
Practice Address - Phone:229-225-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN236174363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health