Organization
MID PROVIDER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA J NORRIS GNP (DIRECTOR)
(404) 229-0274
Entity
Organization
Contact information
Practice address
1230 WORTHINGTON HILLS DR, ROSWELL, GA 30076-1753
(404) 229-0274
(770) 518-4026
Mailing address
1230 WORTHINGTON HILLS DR, ROSWELL, GA 30076-1753
(404) 229-0274
(770) 518-4026
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
RN133089
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD4864
RAILROAD RETIERMENT
GA
Enumeration date
04/24/2007
Last updated
01/05/2010
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