Healthcare Provider Details

I. General information

NPI: 1568508281
Provider Name (Legal Business Name): ADVANCED PRACTICE ENTERPRISES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4036 ADMIRAL DR
CHAMBLEE GA
30341-1514
US

IV. Provider business mailing address

4036 ADMIRAL DR
CHAMBLEE GA
30341-1514
US

V. Phone/Fax

Practice location:
  • Phone: 770-936-8494
  • Fax:
Mailing address:
  • Phone: 770-936-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN137975
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. PATRICIA ANNE BROWER
Title or Position: OWNER
Credential: FNP
Phone: 404-308-8494