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NPI Code Detail

MEDICARE: BOBBY JOE GUESS JR. FNP-C

MEDICARE: BOBBY JOE GUESS JR. FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerRN222767GA

General Provider Information

NPI Number : 1649839994
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOBBY JOE GUESS JR. FNP-C
Provider Business Mailing Address
First Line : 36 BYRON ST
Second Line :
City : PEARSON
State : GA
Zip : 31642-7606
Country : US
Telephone Number : 912-422-8099
Fax Number :
Provider Business Practice Location Address
First Line : 1101 OCILLA RD
Second Line :
City : DOUGLAS
State : GA
Zip : 31533-2262
Country : US
Telephone Number : 912-384-1900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2019
Last Update Date : 06/11/2019

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