Provider Demographics
NPI:1184634420
Name:SONGER, BETTY JO (FNP)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:JO
Last Name:SONGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:GA
Mailing Address - Zip Code:31780-5570
Mailing Address - Country:US
Mailing Address - Phone:229-824-4444
Mailing Address - Fax:229-824-7190
Practice Address - Street 1:107 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:GA
Practice Address - Zip Code:31780
Practice Address - Country:US
Practice Address - Phone:229-824-4444
Practice Address - Fax:229-824-7190
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN063963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ07846Medicare UPIN