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General NPI Number Information
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NPI Number | 1083859193
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Entity Type | Organization
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Legal Business Name | MOSTHOUSE INC
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Dates
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Enumeration Date | 12/04/2008
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | 3201 S COBB DR SE SUITE # D-1
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City | SMYRNA
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State | GA
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Zip | 30080-4190
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Country | US
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Telephone | 770-432-9755
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 S COBB DR SE SUITE # D-1
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City | SMYRNA
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State | GA
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Zip | 30080-4190
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Country | US
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Telephone | 770-432-9755
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | JAMES TURKSON
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Credential |
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Telephone | 770-432-9755
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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 | RN039884
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License Number State | GA
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