Healthcare Provider Details

I. General information

NPI: 1790773273
Provider Name (Legal Business Name): LINDA CHERYL WOUGHTER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4331 THURMON TANNER RD
FLOWERY BRANCH GA
30542-2829
US

IV. Provider business mailing address

4331 THURMON TANNER RD
FLOWERY BRANCH GA
30542-2829
US

V. Phone/Fax

Practice location:
  • Phone: 678-513-5700
  • Fax: 678-513-5700
Mailing address:
  • Phone: 678-513-5700
  • Fax: 678-513-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2849912
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP2849912
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN205309
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: