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General NPI Number Information
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NPI Number | 1740683309
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC NP SERVICES
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Dates
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Enumeration Date | 09/26/2014
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 5228 BRANDYWINE DR
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City | MACON
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State | GA
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Zip | 31210-2902
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Country | US
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Telephone | 478-284-1116
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Fax |
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Provider Business Mailing Address
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Address Line | 5228 BRANDYWINE DR
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City | MACON
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State | GA
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Zip | 31210-2902
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Country | US
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Telephone | 478-284-1116
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | JOAN SAPP MITCHELL
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Credential | NP
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Telephone | 478-284-1116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN063812
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License Number State | GA
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