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General NPI Number Information
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NPI Number | 1265139059
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Entity Type | Organization
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Legal Business Name | MEDXPRESS
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 40 JONESBORO ST STE C
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City | MCDONOUGH
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State | GA
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Zip | 30253-3117
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Country | US
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Telephone | 404-514-1204
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Fax |
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Provider Business Mailing Address
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Address Line | 950 EAGLES LANDING PKWY STE 1024
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7343
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Country | US
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Telephone | 404-514-1204
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUNIENNE RICHARDS
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Credential | NP
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Telephone | 404-514-1204
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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 |
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License Number State |
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