MEDICARE: MS. TOMMIE JOANN FLOYD A.P.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN123475	GA

General Provider Information

NPI Number	:	1013396878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TOMMIE JOANN FLOYD A.P.N.

Provider Business Mailing Address
First Line	:	845 SCENIC HWY
Second Line	:	#100
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-7103
Country	:	US
Telephone Number	:	770-962-6443
Fax Number	:	770-964-8355

Provider Business Practice Location Address
First Line	:	6025 PROFESSIONAL PKWY STE 200
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-5610
Country	:	US
Telephone Number	:	770-949-0555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2015
Last Update Date	:	01/26/2022

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