Healthcare Provider Details

I. General information

NPI: 1437621406
Provider Name (Legal Business Name): EMILY USSERY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2019
Last Update Date: 01/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 PEACHTREE PKWY # 302
CUMMING GA
30041-6834
US

IV. Provider business mailing address

1105 CHIPWOOD PATH
TUCKER GA
30084-1434
US

V. Phone/Fax

Practice location:
  • Phone: 770-772-1830
  • Fax:
Mailing address:
  • Phone: 770-510-9951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN216026
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: