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NPI Code Detail

MEDICARE: MRS. SNAVLY FENELON

MEDICARE: MRS. SNAVLY FENELON
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
1363LF0000XFamily Nurse PractitionerF1016852GA

General Provider Information

NPI Number : 1760925135
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SNAVLY FENELON
Provider Business Mailing Address
First Line : 1075 LAFAYETTE PKWY STE 100
Second Line :
City : LAGRANGE
State : GA
Zip : 30241-3507
Country : US
Telephone Number : 706-443-5273
Fax Number : 762-323-1014
Provider Business Practice Location Address
First Line : 1075 LAFAYETTE PKWY STE 100
Second Line :
City : LAGRANGE
State : GA
Zip : 30241-3507
Country : US
Telephone Number : 706-443-5273
Fax Number : 762-323-1014
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2016
Last Update Date : 04/19/2018

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Directions to “ MRS. SNAVLY FENELON ” Practice Location

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