MEDICARE: CHARMAINE DOWNER FNP

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	RN213607	GA

General Provider Information

NPI Number	:	1730531419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARMAINE DOWNER FNP

Provider Business Mailing Address
First Line	:	2615 PADDOCK POINT PL
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-7572
Country	:	US
Telephone Number	:	352-205-6891
Fax Number	:

Provider Business Practice Location Address
First Line	:	1580 BOGGS RD
Second Line	:	#700
City	:	DULUTH
State	:	GA
Zip	:	30096-1229
Country	:	US
Telephone Number	:	770-255-0790
Fax Number	:

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

Provider Enumeration Date	:	07/06/2016
Last Update Date	:	07/06/2016

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