Healthcare Provider Details

I. General information

NPI: 1851602874
Provider Name (Legal Business Name): JULES CHOPIN SYBERT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 W. BANKHEAD HWY
VILLA RICA GA
30180
US

IV. Provider business mailing address

736 W. BANKHEAD HWY
VILLA RICA GA
30180
US

V. Phone/Fax

Practice location:
  • Phone: 678-327-8702
  • Fax:
Mailing address:
  • Phone: 678-327-8702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN175586
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: