Healthcare Provider Details

I. General information

NPI: 1124845771
Provider Name (Legal Business Name): JONI HOWARD ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 BYRD WAY
WARNER ROBINS GA
31088-8937
US

IV. Provider business mailing address

130 BYRD WAY
WARNER ROBINS GA
31088-8937
US

V. Phone/Fax

Practice location:
  • Phone: 478-922-9136
  • Fax:
Mailing address:
  • Phone: 478-922-9136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN193530
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN193530
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: