Healthcare Provider Details

I. General information

NPI: 1407551880
Provider Name (Legal Business Name): ERIN ELISABETH FAVINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 JANMAR RD
SNELLVILLE GA
30078-5606
US

IV. Provider business mailing address

1551 JANMAR RD
SNELLVILLE GA
30078-5606
US

V. Phone/Fax

Practice location:
  • Phone: 404-620-6159
  • Fax:
Mailing address:
  • Phone: 678-344-8900
  • Fax: 678-691-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN269772
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN269772
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: