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General NPI Number Information
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NPI Number | 1568266005
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Entity Type | Individual
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Provider Name | JOHN GODFREY FISHER IV MSN, FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 617 PALISADE DR
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City | BRUNSWICK
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State | GA
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Zip | 31523-8211
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Country | US
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Telephone | 912-694-1094
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Fax |
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Provider Business Mailing Address
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Address Line | 1464 GOLF TERRACE BLVD APT 1
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City | FLORENCE
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State | SC
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Zip | 29501-0227
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Country | US
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Telephone |
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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 | 28844
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License Number State | SC
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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 | GAA-NP002713
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License Number State | GA
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