Individual
MAXINE MCGOWAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, PHD, FNP-C
Contact information
Practice address
3866 AUGUSTINE PL, REX, GA 30273-5822
(678) 343-1257
(770) 507-2352
Mailing address
6571 YARBROUGH DR, FAIRBURN, GA 30213-4649
(678) 343-1257
(770) 306-8720
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
26NR07760600
NJ
363LP2300X
Primary Care Nurse Practitioner
Primary
RN201165
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8482306
—
NJ
Enumeration date
01/16/2007
Last updated
07/08/2013
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