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General NPI Number Information
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NPI Number | 1578892071
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Entity Type | Individual
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Provider Name | CATHLEEN ANN PROVINS RN, ACNP-BC, PHD
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Gender | Female
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Dates
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Enumeration Date | 12/11/2009
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 550 PEACHTREE ST NE BLDG 324
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City | ATLANTA
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State | GA
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Zip | 30308
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Country | US
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Telephone | 404-686-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 550 PEACHTREE STREET -DAVIS FISCHER BUILDING OFFICE 324 SUITE 350
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City | ATLANTA
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State | GA
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Zip | 30308
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Country | US
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Telephone | 404-686-1000
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN098946
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License Number State | GA
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