MEDICARE: NEONATAL NURSE PRACTITIONER SERVICES OF GA., LLC

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	363LN0005X	Critical Care Neonatal Nurse Practitioner

General Provider Information

NPI Number	:	1922632744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEONATAL NURSE PRACTITIONER SERVICES OF GA., LLC

Provider Business Mailing Address
First Line	:	1608 GREAT PINE RD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-2819
Country	:	US
Telephone Number	:	205-913-6224
Fax Number	:	205-854-5284

Provider Business Practice Location Address
First Line	:	1608 GREAT PINE RD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-2819
Country	:	US
Telephone Number	:	205-913-6224
Fax Number	:	205-854-5284

Authorized Official
Title or Position	:	CRNP
Name	:	DEBORAH DRISKILL
Credential	:
Telephone Number	:	205-913-6224

Provider Enumeration Date	:	03/02/2020
Last Update Date	:	03/02/2020

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