Provider Demographics
NPI:1205370558
Name:SUMMER, GEORGIANNE ASHLEY (AG-ACNP)
Entity Type:Individual
Prefix:DR
First Name:GEORGIANNE
Middle Name:ASHLEY
Last Name:SUMMER
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 ROSCOE DAVIS RD SW
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-7915
Mailing Address - Country:US
Mailing Address - Phone:404-375-7149
Mailing Address - Fax:
Practice Address - Street 1:538 ROSCOE DAVIS RD SW
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30656-7915
Practice Address - Country:US
Practice Address - Phone:404-375-7149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA165199363LA2200X, 364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care