Healthcare Provider Details

I. General information

NPI: 1548256233
Provider Name (Legal Business Name): RENE GUILD APRN, FNP-BC, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 03/07/2023
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 BLUE RIDGE OVERLOOK
BLUE RIDGE GA
30513-4431
US

IV. Provider business mailing address

165 BLUE RIDGE OVERLOOK
BLUE RIDGE GA
30513-4431
US

V. Phone/Fax

Practice location:
  • Phone: 706-946-4647
  • Fax: 706-374-7628
Mailing address:
  • Phone: 706-946-5600
  • Fax: 706-374-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberRN078829NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: