Healthcare Provider Details

I. General information

NPI: 1629987441
Provider Name (Legal Business Name): JUSTIN EMBRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W 3RD AVE
ALBANY GA
31701-1943
US

IV. Provider business mailing address

2820 SOMERSET DR
ALBANY GA
31721-9103
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-5808
  • Fax: 229-312-4315
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number236047
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: