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General NPI Number Information
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NPI Number | 1699430660
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Entity Type | Organization
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Legal Business Name | HOMETOWN HEALTHCARE OF BYRON LLC
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 103 MOSELEY RD
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City | BYRON
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State | GA
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Zip | 31008-7148
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Country | US
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Telephone | 478-654-5327
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Fax | 478-654-5218
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Provider Business Mailing Address
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Address Line | PO BOX 2247
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City | BYRON
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State | GA
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Zip | 31008-2247
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Country | US
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Telephone | 478-654-5327
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Fax | 478-654-5218
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Authorized Official
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Title or Position | MEMBER
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Name | HALEY PULLIAM
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Credential |
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Telephone | 478-654-5327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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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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