Healthcare Provider Details

I. General information

NPI: 1598463630
Provider Name (Legal Business Name): AMBER K RETTIG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 E MAIN ST STE 201
CARTERSVILLE GA
30120-3278
US

IV. Provider business mailing address

333 N SUMMIT ST FL 15
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 800-427-1902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN285353
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: