Individual
MRS. TEMICA BOHANNON NIBLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 HALCYON CT, FAYETTEVILLE, GA 30214-5375
(770) 241-6044
Mailing address
100 HALCYON CT, FAYETTEVILLE, GA 30214-5375
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN157878
GA
363LG0600X
Gerontology Nurse Practitioner
RN157878
GA
Other
Enumeration date
03/10/2016
Last updated
03/10/2016
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