Basic Information
| Provider Information | |||||||||
| NPI: | 1255991667 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH ADVOCATE PORTABLE PRACTITIONER TO YOU LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1365 OLD MILL RD | ||||||||
| Address2: | |||||||||
| City: | CORNELIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305314863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707897927 | ||||||||
| FaxNumber: | 7067787285 | ||||||||
| Practice Location | |||||||||
| Address1: | 1365 OLD MILL RD | ||||||||
| Address2: | |||||||||
| City: | CORNELIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305314863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707897927 | ||||||||
| FaxNumber: | 7067787285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2019 | ||||||||
| LastUpdateDate: | 06/19/2019 | ||||||||
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| AuthorizedOfficialLastName: | SWILLEY | ||||||||
| AuthorizedOfficialFirstName: | GINGER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7707897927 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FNP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 363LF0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.