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General NPI Number Information
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NPI Number | 1639657620
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Entity Type | Individual
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Provider Name | JULIENNE KALOMBO THOMAS FNP
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Gender | Female
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Dates
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Enumeration Date | 08/01/2018
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 771 OLD NORCROSS RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4386
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Country | US
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Telephone | 770-923-4433
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Fax |
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Provider Business Mailing Address
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Address Line | 770 OLD NORCROSS RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4318
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Country | US
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Telephone | 770-923-4433
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Fax | 770-979-5162
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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 | RN237797
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License Number State | GA
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