Provider Demographics
NPI:1619668316
Name:ENAGBARE, JOY (NP)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:
Last Name:ENAGBARE
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 1:20 PURPLETOP DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-4168
Mailing Address - Country:US
Mailing Address - Phone:770-369-2411
Mailing Address - Fax:
Practice Address - Street 1:20 PURPLETOP DR
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-4168
Practice Address - Country:US
Practice Address - Phone:770-369-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN175444363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health