Healthcare Provider Details

I. General information

NPI: 1306621388
Provider Name (Legal Business Name): COURTNEY MICHELLE ANDERSON AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 S HOUSTON LAKE RD STE 100
WARNER ROBINS GA
31088-6374
US

IV. Provider business mailing address

470 S HOUSTON LAKE RD STE 100
WARNER ROBINS GA
31088-6374
US

V. Phone/Fax

Practice location:
  • Phone: 478-971-1099
  • Fax: 478-971-1098
Mailing address:
  • Phone: 478-971-1099
  • Fax: 478-971-1098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN250932
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN250932
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: