MEDICARE: ALAINA CANDICE BISHOP FNP-C

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	363L00000X	Nurse Practitioner	RN268384	GA

General Provider Information

NPI Number	:	1619750486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAINA CANDICE BISHOP FNP-C

Provider Business Mailing Address
First Line	:	221 TECHNOLOGY PKWY NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1369
Country	:	US
Telephone Number	:	762-235-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5470 MARTHA BERRY HWY NE
Second Line	:
City	:	ARMUCHEE
State	:	GA
Zip	:	30105-2302
Country	:	US
Telephone Number	:	762-235-3830
Fax Number	:	706-291-9391

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

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	09/20/2023

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