Provider Demographics
NPI:1932312899
Name:GUICE, EMMA M (FNP)
Entity Type:Individual
Prefix:MS
First Name:EMMA
Middle Name:M
Last Name:GUICE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:EMMA
Other - Middle Name:M
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FAMILY NURSE PRACTIT
Mailing Address - Street 1:3273 BARNWELL TRCE
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-5046
Mailing Address - Country:US
Mailing Address - Phone:678-797-2019
Mailing Address - Fax:770-499-3655
Practice Address - Street 1:1000 CHASTAIN RD NW
Practice Address - Street 2:HOUSE 52, STUDENT HEALTH CLINIC
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5588
Practice Address - Country:US
Practice Address - Phone:678-797-2019
Practice Address - Fax:770-499-3655
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN095654390200000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily