Healthcare Provider Details

I. General information

NPI: 1336424522
Provider Name (Legal Business Name): CYNTHIA DIANNE DAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 EAST VILLANOW STREET
LAFAYETTE GA
30728
US

IV. Provider business mailing address

611 EAST VILLANOW STREET
LAFAYETTE GA
30728
US

V. Phone/Fax

Practice location:
  • Phone: 706-638-1606
  • Fax: 706-638-9987
Mailing address:
  • Phone: 706-638-1606
  • Fax: 706-638-9987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN122559
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN16089
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16089
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: