Healthcare Provider Details
I. General information
NPI: 1669456380
Provider Name (Legal Business Name): GLORIA LYNN DOWNEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 12/06/2005
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3421 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US
IV. Provider business mailing address
3421 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US
V. Phone/Fax
- Phone: 706-432-7893
- Fax: 706-432-3780
- Phone: 706-432-7893
- Fax: 706-432-3780
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | RN099709 |
| License Number State | GA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: