Healthcare Provider Details

I. General information

NPI: 1073696068
Provider Name (Legal Business Name): JULIE G. BIRD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 06/27/2024
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 HIGHWAY 25 N
MILLEN GA
30442-6713
US

IV. Provider business mailing address

416 PINE ST
SYLVANIA GA
30467-2036
US

V. Phone/Fax

Practice location:
  • Phone: 478-401-0477
  • Fax: 888-375-0624
Mailing address:
  • Phone: 912-564-2182
  • Fax: 912-564-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN235467
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: