Provider Demographics
NPI:1245392695
Name:OWENS, PAIGE E (FNP, BC)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:E
Last Name:OWENS
Suffix:
Gender:F
Credentials:FNP, BC
Other - Prefix:
Other - First Name:TIFFANIE
Other - Middle Name:PAIGE
Other - Last Name:ELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP, BC
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-535-0191
Practice Address - Fax:770-535-0916
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN124242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00750966OtherMEDICARE RAILROAD
GA01288547OtherAMERIGROUP
GA725746613AMedicaid
GA476707OtherWELLCARE
GA511I500714Medicare PIN
GA476707OtherWELLCARE