Provider Demographics
NPI:1518370196
Name:PRYOR, JULIE (NP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:PRYOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 RIVERSIDE PKWY
Mailing Address - Street 2:C/O PROHEALTH
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5996
Mailing Address - Country:US
Mailing Address - Phone:770-513-0111
Mailing Address - Fax:770-513-3731
Practice Address - Street 1:1431 RIVERSIDE PKWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5996
Practice Address - Country:US
Practice Address - Phone:770-513-0111
Practice Address - Fax:770-513-3731
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN073134163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse