# NURSE PRACTIONER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** INDEPENDENT CONTRACTOR
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1629519202
- **Legal business name:** INDEPENDENT CONTRACTOR
- **Authorized official:** ROSE KOMBE NP (FNP)
- **Authorized official phone:** (404) 579-1658

## Contact information

- **Practice address:** 4044 GEORGE BUSBEE PKWY NW APT 4207, KENNESAW, GA 30144-6890
- **Practice address phone:** (404) 579-1658
- **Mailing address:** PO BOX 1234, POWDER SPRINGS, GA 30127-7234
- **Mailing address phone:** (404) 579-1658

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | 193760 | GA | Yes |
| 305S00000X | Point of Service | 193760 | GA | — |

## Other

- **Enumeration date:** 03/15/2017
- **Last updated:** 03/15/2017