Basic Information
| Provider Information | |||||||||
| NPI: | 1295233534 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | JUNE | ||||||||
| MiddleName: | R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1993 NORWOOD ROGERS RD | ||||||||
| Address2: | |||||||||
| City: | CLAXTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304172937 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 466 S GRAY ST | ||||||||
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| City: | MILLEN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304425237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789822531 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2018 | ||||||||
| LastUpdateDate: | 01/31/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 154206 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.