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General NPI Number Information
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NPI Number | 1295491595
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Entity Type | Organization
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Legal Business Name | DENTON FAMILY CLINIC LLC
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 12 SAMMY MCGHEE BLVD STE 204
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City | JASPER
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State | GA
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Zip | 30143-7712
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Country | US
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Telephone | 770-894-7820
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Fax |
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Provider Business Mailing Address
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Address Line | 12 SAMMY MCGHEE BLVD STE 204
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City | JASPER
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State | GA
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Zip | 30143-7712
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Country | US
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Telephone | 770-894-7820
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELAINA AVERETT
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Credential |
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Telephone | 770-894-7820
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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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