Organization
NURSE PRACTIONER
Active
Parent organization
INDEPENDENT CONTRACTOR
Organization subpart
Yes
Provider details
NPI number
Legal business name
INDEPENDENT CONTRACTOR
Authorized official
ROSE KOMBE NP (FNP)
(404) 579-1658
Entity
Organization
Contact information
Practice address
4044 GEORGE BUSBEE PKWY NW APT 4207, KENNESAW, GA 30144-6890
(404) 579-1658
Mailing address
PO BOX 1234, POWDER SPRINGS, GA 30127-7234
(404) 579-1658
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
193760
GA
305S00000X
Point of Service
193760
GA
Other
Enumeration date
03/15/2017
Last updated
03/15/2017
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