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General NPI Number Information
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NPI Number | 1285279737
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Entity Type | Individual
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Provider Name | MIA DENISE PICKARD BC-FNP
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Gender | Female
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Dates
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Enumeration Date | 11/07/2019
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 1826 VETERANS BLVD
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City | DUBLIN
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State | GA
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Zip | 31021-3620
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Country | US
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Telephone | 478-272-1210
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Fax |
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Provider Business Mailing Address
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Address Line | 105 COTTAGE LOOP
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City | DUBLIN
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State | GA
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Zip | 31021-2564
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Country | US
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Telephone | 478-484-9393
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | RN197273
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License Number State | GA
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