Healthcare Provider Details

I. General information

NPI: 1033827811
Provider Name (Legal Business Name): ALLISON BRICE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 BLACK BEAR RDG
SAUTEE NACOOCHEE GA
30571-3559
US

IV. Provider business mailing address

32 BLACK BEAR RDG
SAUTEE NACOOCHEE GA
30571-3559
US

V. Phone/Fax

Practice location:
  • Phone: 912-850-7954
  • Fax:
Mailing address:
  • Phone: 912-850-7954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN209151
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: