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General NPI Number Information
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NPI Number | 1255768024
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF JUVENILE JUSTICE
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Dates
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Enumeration Date | 10/10/2013
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Last Update Date | 10/10/2013
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Provider Practice Location Address
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Address Line | 450 CRESCENT DR
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City | GAINESVILLE
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State | GA
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Zip | 30501-5079
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Country | US
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Telephone | 770-531-6083
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Fax | 770-531-4587
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Provider Business Mailing Address
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Address Line | 540 CRESENT DR
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City | GAINESVILLE
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State | GA
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Zip | 30501-5079
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Country | US
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Telephone | 770-531-6083
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Fax | 770-531-4587
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Authorized Official
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Title or Position | FNPC
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Name | ALMA GARRETT
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Credential | FNP
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Telephone | 770-531-6083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | RN069188
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License Number State | GA
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