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General NPI Number Information
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NPI Number | 1891238606
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Entity Type | Organization
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Legal Business Name | SOUTHERN CROSS AT HOME LLC
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 11/28/2016
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Provider Practice Location Address
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Address Line | 980 BIRMINGHAM RD STE 501-330
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City | MILTON
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State | GA
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Zip | 30004-4417
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Country | US
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Telephone | 770-317-8244
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Fax |
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Provider Business Mailing Address
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Address Line | 980 BIRMINGHAM RD STE 501-330
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City | MILTON
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State | GA
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Zip | 30004-4417
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Country | US
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Telephone | 770-317-8244
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Fax |
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Authorized Official
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Title or Position | OWNER - FOUNDER
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Name | MS. KIMBERLY BUNKER
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Credential | APRN, FNP-BC, NP-C
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Telephone | 770-317-8244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | FNP/RN173575
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License Number State | GA
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