Individual
REBECCA FONDREN HUMPHRIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
303 SMITH STREET, EMORY CLARK HOLDER CLINIC, LAGRANGE, GA 30240
(706) 882-8831
(706) 812-4091
Mailing address
303 SMITH STREET, EMORY CLARK HOLDER CLINIC, LAGRANGE, GA 30240
(706) 882-8831
(706) 812-4091
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN175845 NP
GA
363LA2200X
Adult Health Nurse Practitioner
Primary
RN175845 NP
GA
363LP2300X
Primary Care Nurse Practitioner
RN175845 NP
GA
Other
Enumeration date
11/06/2008
Last updated
11/07/2008
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