Organization
IT'S A DRAW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARONDA FORTE NURSE PRACTITIONER (CEO)
(270) 987-1338
Entity
Organization
Contact information
Practice address
1970 MAIN ST E STE B3, SNELLVILLE, GA 30078-6463
(470) 467-4680
Mailing address
1970 MAIN ST E STE B3, SNELLVILLE, GA 30078-6463
(470) 467-4680
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003246533A
—
GA
01
—
11D2235621
MOBILE LAB
GA
Enumeration date
09/21/2021
Last updated
02/25/2022
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