Provider Demographics
NPI:1396497236
Name:RISH, JONATHAN (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:RISH
Suffix:
Gender:M
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5997 ASH HILL PL
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-4115
Mailing Address - Country:US
Mailing Address - Phone:850-960-9581
Mailing Address - Fax:
Practice Address - Street 1:256 MCMILLAN RD
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-2337
Practice Address - Country:US
Practice Address - Phone:770-624-2728
Practice Address - Fax:770-353-9819
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN271537163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse