Individual
JUSTIN LEE BANISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0001
(706) 721-7386
Mailing address
1026 IRIS GLEN DR, EVANS, GA 30809-9300
(706) 604-9005
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-160425
AL
Other
Enumeration date
06/10/2019
Last updated
09/27/2022
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