Healthcare Provider Details

I. General information

NPI: 1932312899
Provider Name (Legal Business Name): EMMA M. GUICE F.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMA M. JACKSON FAMILY NURSE PRACTIT

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CHASTAIN RD NW HOUSE 52, STUDENT HEALTH CLINIC
KENNESAW GA
30144-5588
US

IV. Provider business mailing address

3273 BARNWELL TRCE
POWDER SPRINGS GA
30127-5046
US

V. Phone/Fax

Practice location:
  • Phone: 678-797-2019
  • Fax: 770-499-3655
Mailing address:
  • Phone: 678-797-2019
  • Fax: 770-499-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN095654
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP095654
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN095654
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: