Healthcare Provider Details

I. General information

NPI: 1700358140
Provider Name (Legal Business Name): CHARLOTTE DAVID FNP, BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 BREEDLOVE DR STE A
MONROE GA
30655-2054
US

IV. Provider business mailing address

PO BOX 5856
ATLANTA GA
31107-0856
US

V. Phone/Fax

Practice location:
  • Phone: 888-772-0076
  • Fax: 770-751-8014
Mailing address:
  • Phone: 888-772-0076
  • Fax: 770-751-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN215851
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: