Provider Demographics
NPI:1750319463
Name:CHILDREE, RENE B (MSN RN CS FNP)
Entity Type:Individual
Prefix:MRS
First Name:RENE
Middle Name:B
Last Name:CHILDREE
Suffix:
Gender:F
Credentials:MSN RN CS FNP
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Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:BROOKLET
Mailing Address - State:GA
Mailing Address - Zip Code:30415
Mailing Address - Country:US
Mailing Address - Phone:912-842-2101
Mailing Address - Fax:912-842-2103
Practice Address - Street 1:128 NORTH PARKER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLET
Practice Address - State:GA
Practice Address - Zip Code:30415
Practice Address - Country:US
Practice Address - Phone:912-842-2101
Practice Address - Fax:912-842-2103
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN043261 NP207Q00000X
GARN043261363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00510518AMedicaid
GA50BBGDRMedicare ID - Type Unspecified
GA00510518AMedicaid
GAP02501Medicare UPIN