Provider Demographics
NPI:1689435448
Name:MULBERRY PRIMARY CARE LLC
Entity Type:Organization
Organization Name:MULBERRY PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOCILLI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:678-736-0460
Mailing Address - Street 1:2716 WILDFLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-3653
Mailing Address - Country:US
Mailing Address - Phone:678-736-0460
Mailing Address - Fax:
Practice Address - Street 1:831 AUBURN RD STE 230
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-5437
Practice Address - Country:US
Practice Address - Phone:678-232-7332
Practice Address - Fax:470-300-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty