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General NPI Number Information
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NPI Number | 1285064931
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Entity Type | Organization
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Legal Business Name | SJ &J MEDICAL GROUP AND URGENT CARE
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Dates
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Enumeration Date | 11/16/2013
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Last Update Date | 11/16/2013
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Provider Practice Location Address
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Address Line | 304 SMITH ST
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City | LAGRANGE
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State | GA
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Zip | 30240-2746
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Country | US
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Telephone | 706-882-0382
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Fax |
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Provider Business Mailing Address
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Address Line | 304 SMITH ST
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City | LAGRANGE
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State | GA
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Zip | 30240-2746
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Country | US
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Telephone | 706-882-0382
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/MANAGER
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Name | MRS. CHRISTINA ANDERSON
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Credential | NP-C
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Telephone | 706-593-7766
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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 | RN154861NP
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License Number State | GA
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