Individual
FARAH OCTAVIEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
2873 VILLAGE PARK DR E, ELLENWOOD, GA 30294-5712
(678) 571-0918
Mailing address
2873 VILLAGE PARK DR E, ELLENWOOD, GA 30294-5712
(678) 571-0918
Taxonomy
Speciality
Code
Description
License number
State
364SG0600X
Gerontology Clinical Nurse Specialist
Primary
AG03190021
GA
Other
Enumeration date
09/22/2019
Last updated
09/22/2019
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