Individual
FALLON WORTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 BRAXTON CT, FAYETTEVILLE, GA 30214-1968
(770) 461-6422
Mailing address
9 PINE GROVE CIR, NEWNAN, GA 30263-2897
(678) 516-1160
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
191643
GA
Other
Enumeration date
01/05/2024
Last updated
01/05/2024
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