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Mid Provider Inc
Gerontology Nurse Practitioner in Roswell, Georgia
NPI 1962621532

Mid Provider Inc is a Gerontology Nurse Practitioner based in Roswell, GA and is specialized in Gerontology. Mid Provider Inc practices in Roswell, GA. The NPI Number for Mid Provider Inc is 1962621532 and holds a License No. RN133089 (Georgia).

The current practice location address for Mid Provider Inc is 1230 Worthington Hills Dr, Roswell, GA and can be reached out via phone at 404-229-0274 and via fax at 770-518-4026.

Location: 1230 Worthington Hills Dr, Roswell, GA, 30076-1753
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1962621532
Provider Name
Mid Provider Inc
Credential
Provider Entity Type
Organization
Address
1230 Worthington Hills Dr, Roswell, GA, 30076-1753
Phone Number
404-229-0274
Fax Number
770-518-4026
Provider Enumeration Date
04/24/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
DD4864 01 GA RAILROAD RETIERMENT
institution
Provider Business Practice Location Address Details
Address
1230 Worthington Hills Dr
City
Roswell
State
Georgia
Zip
30076-1753
Phone Number
404-229-0274
Fax Number
770-518-4026
person
Provider Business Mailing Address Details
Address
1230 Worthington Hills Dr
City
Roswell
State
Georgia
Zip
30076-1753
Phone Number
404-229-0274
Fax Number
770-518-4026
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Gerontology
Taxonomy
363LG0600X
License No.
RN133089 (Georgia)
Definition
Definition to come...
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