Healthcare Provider Details

I. General information

NPI: 1487094876
Provider Name (Legal Business Name): MS. JANET LYNEESE PIPPINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 BRASCH PARK DR
GRANTVILLE GA
30220-2139
US

IV. Provider business mailing address

108 BRASCH PARK DR
GRANTVILLE GA
30220-2139
US

V. Phone/Fax

Practice location:
  • Phone: 404-357-2329
  • Fax:
Mailing address:
  • Phone: 404-357-2329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number20130075
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: