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General NPI Number Information
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NPI Number | 1427678259
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Entity Type | Individual
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Provider Name | CATHY DEE GIOMBLANCO ARNP
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Gender | Female
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 3703 SOUTHLAND DR
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City | BUFORD
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State | GA
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Zip | 30519-7096
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Country | US
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Telephone | 954-393-4219
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Fax |
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Provider Business Mailing Address
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Address Line | 3703 SOUTHLAND DR
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City | BUFORD
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State | GA
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Zip | 30519-7096
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Country | US
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Telephone | 954-393-4219
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11006894
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 294046
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 110411
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License Number State | WV
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