Healthcare Provider Details

I. General information

NPI: 1578784187
Provider Name (Legal Business Name): MARY FAYE ARMOUR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 SCOGGINS DRIVE
DEMOREST GA
30535
US

IV. Provider business mailing address

POBOX 58
ALTO GA
30510
US

V. Phone/Fax

Practice location:
  • Phone: 706-778-7156
  • Fax: 706-776-7694
Mailing address:
  • Phone: 706-778-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN067066
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: