Individual
MAXINE FOMUNUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
409 OLD BORING LN, WOODSTOCK, GA 30189-2495
(470) 461-3426
(770) 928-7558
Mailing address
3206 THIMBLEBERRY TRL, DACULA, GA 30019-7299
(470) 461-3426
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN291792
GA
Other
Enumeration date
11/10/2023
Last updated
03/18/2025
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