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NPI Code Detail

MEDICARE: DEBORAH BUTLER

MEDICARE: DEBORAH BUTLER
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 PractitionerF0115164GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891178745
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH BUTLER
Provider Business Mailing Address
First Line : 200 N LEWIS ST
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-2738
Country : US
Telephone Number : 706-887-5787
Fax Number : 706-780-5402
Provider Business Practice Location Address
First Line : 200 N LEWIS ST
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-2738
Country : US
Telephone Number : 706-887-5787
Fax Number : 706-780-5402
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2015
Last Update Date : 03/04/2020

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