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General NPI Number Information
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NPI Number | 1538755749
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Entity Type | Organization
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Legal Business Name | A TRAVELING HEART
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Dates
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Enumeration Date | 12/12/2020
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 9190 GALLITIN DR SW
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City | COVINGTON
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State | GA
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Zip | 30014-3034
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Country | US
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Telephone | 470-631-4035
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Fax |
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Provider Business Mailing Address
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Address Line | 9190 GALLITIN DR SW
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City | COVINGTON
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State | GA
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Zip | 30014-3034
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Country | US
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Telephone | 470-631-4035
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | TABRIA COLSTON
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Credential | TABRIA COLSTON
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Telephone | 470-631-4035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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