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General NPI Number Information
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NPI Number | 1043561095
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Entity Type | Organization
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Legal Business Name | LIVING WELL HOUSE CALLS LLC
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Dates
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Enumeration Date | 09/29/2012
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Last Update Date | 09/29/2012
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Provider Practice Location Address
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Address Line | 607 4TH ST W
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City | DARIEN
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State | GA
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Zip | 31305-9362
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Country | US
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Telephone | 912-580-0440
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Fax |
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Provider Business Mailing Address
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Address Line | 607 4TH ST W
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City | DARIEN
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State | GA
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Zip | 31305-9362
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Country | US
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Telephone | 912-580-0440
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JOANNE ELLEN BRACEWELL
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Credential | ARNP-C
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Telephone | 912-580-0440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 217510
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License Number State | GA
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