Healthcare Provider Details

I. General information

NPI: 1194420778
Provider Name (Legal Business Name): JO ELLEN SNODGRASS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7887 ROSWELL RD
ATLANTA GA
30350-4829
US

IV. Provider business mailing address

7887 ROSWELL RD
ATLANTA GA
30350-4829
US

V. Phone/Fax

Practice location:
  • Phone: 404-635-6644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN239499
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN239499
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: