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General NPI Number Information
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NPI Number | 1902423163
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Entity Type | Organization
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Legal Business Name | ASCENDE HEALTHCARE
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 1880 BRASELTON HWY STE 118
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-2877
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Country | US
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Telephone | 770-322-4373
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Fax | 912-214-2143
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Provider Business Mailing Address
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Address Line | 1880 BRASELTON HWY STE 118
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-2877
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Country | US
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Telephone | 770-322-4373
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Fax | 912-214-2143
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Authorized Official
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Title or Position | CEO
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Name | DR. CALLIE LOGAN
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Credential | DNP, FNP-C
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Telephone | 770-322-4373
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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 |
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License Number State |
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