Healthcare Provider Details

I. General information

NPI: 1558019687
Provider Name (Legal Business Name): JANELL ELLEN SPURLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 FORREST DR
PALMETTO GA
30268-1356
US

IV. Provider business mailing address

255 FORREST DR
PALMETTO GA
30268-1356
US

V. Phone/Fax

Practice location:
  • Phone: 720-937-2288
  • Fax:
Mailing address:
  • Phone: 720-937-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN263425
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: