Healthcare Provider Details

I. General information

NPI: 1891972964
Provider Name (Legal Business Name): MERLE JOAN POORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 ATHENS ST
GAINESVILLE GA
30507-7000
US

IV. Provider business mailing address

1280 ATHENS ST
GAINESVILLE GA
30507-7000
US

V. Phone/Fax

Practice location:
  • Phone: 770-535-5743
  • Fax: 770-535-5958
Mailing address:
  • Phone: 770-535-5743
  • Fax: 770-535-5958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN118965
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: