Healthcare Provider Details

I. General information

NPI: 1255452512
Provider Name (Legal Business Name): JANIE CAROL MCCOY RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 ATHENS ST
GAINESVILLE GA
30507-7000
US

IV. Provider business mailing address

482 W RUSS STEPHENS RD
MOUNT AIRY GA
30563-3338
US

V. Phone/Fax

Practice location:
  • Phone: 770-535-5743
  • Fax:
Mailing address:
  • Phone: 706-778-3263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN049565
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: