Healthcare Provider Details

I. General information

NPI: 1639582281
Provider Name (Legal Business Name): ELIZABETH SINGLETARY MANSFIELD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 COLLEGE ST
BLAKELY GA
39823-2554
US

IV. Provider business mailing address

360 COLLEGE ST
BLAKELY GA
39823-2554
US

V. Phone/Fax

Practice location:
  • Phone: 229-723-2660
  • Fax: 229-723-2663
Mailing address:
  • Phone: 229-723-2660
  • Fax: 229-723-2663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN183513
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: