=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548256233
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENE GUILD APRN, FNP-BC, CDE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2005
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 165 BLUE RIDGE OVERLOOK
-----------------------------------------------------
City | BLUE RIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30513-4431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-946-4647
-----------------------------------------------------
Fax | 706-374-7628
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 165 BLUE RIDGE OVERLOOK
-----------------------------------------------------
City | BLUE RIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30513-4431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-946-5600
-----------------------------------------------------
Fax | 706-374-7628
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Nurse Practitioner
-----------------------------------------------------
License Number | RN078829NP
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------