Healthcare Provider Details

I. General information

NPI: 1447333471
Provider Name (Legal Business Name): ANITA M ROSS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NORMAN DORMINY DR STE A
FITZGERALD GA
31750-8858
US

IV. Provider business mailing address

117 KITE RD
SWAINSBORO GA
30401-3231
US

V. Phone/Fax

Practice location:
  • Phone: 229-409-0874
  • Fax: 229-424-7392
Mailing address:
  • Phone: 478-289-1303
  • Fax: 478-289-7466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN102271 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: