Healthcare Provider Details

I. General information

NPI: 1407908106
Provider Name (Legal Business Name): JANE NORMAN RN-FIRST ASSIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3193 HOWELL MILL RD NW STE 328
ATLANTA GA
30327-2119
US

IV. Provider business mailing address

PO BOX 134
HIGHLAND IL
62249-0134
US

V. Phone/Fax

Practice location:
  • Phone: 404-350-9355
  • Fax: 404-350-9069
Mailing address:
  • Phone: 618-654-3800
  • Fax: 618-654-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN048973
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: