Healthcare Provider Details

I. General information

NPI: 1538012463
Provider Name (Legal Business Name): COURTNEY N GARDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5126 HOSPITAL DR NE
COVINGTON GA
30014-2566
US

IV. Provider business mailing address

506 COWPENS RD
SOCIAL CIRCLE GA
30025-2967
US

V. Phone/Fax

Practice location:
  • Phone: 770-385-4414
  • Fax:
Mailing address:
  • Phone: 770-597-1763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN268812
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: