Provider Demographics
NPI:1326890914
Name:NA, JOSEPHINE (FNP)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:NA
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 1:4995 LANIER ISLANDS PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1741
Mailing Address - Country:US
Mailing Address - Phone:770-877-0238
Mailing Address - Fax:
Practice Address - Street 1:4995 LANIER ISLANDS PKWY STE A
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-1741
Practice Address - Country:US
Practice Address - Phone:678-546-5059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN306723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily