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General NPI Number Information
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NPI Number | 1396497236
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Entity Type | Individual
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Provider Name | JONATHAN RISH MSN, APRN, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 256 MCMILLAN RD
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City | DACULA
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State | GA
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Zip | 30019-2337
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Country | US
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Telephone | 770-624-2728
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Fax | 770-353-9819
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Provider Business Mailing Address
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Address Line | 5997 ASH HILL PL
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City | HOSCHTON
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State | GA
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Zip | 30548-4115
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Country | US
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Telephone | 850-960-9581
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN271537
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN271537
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License Number State | GA
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