Basic Information
| Provider Information | |||||||||
| NPI: | 1639174600 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUGGAR | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | DARLENE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DUGGAR | ||||||||
| OtherFirstName: | GINA | ||||||||
| OtherMiddleName: | WHITE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | NP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 531 ROSELANE ST NW STE 710 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300606975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783313297 | ||||||||
| FaxNumber: | 6785817187 | ||||||||
| Practice Location | |||||||||
| Address1: | 157 CLINIC AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301174454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703332220 | ||||||||
| FaxNumber: | 6785817180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 01/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN130310 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1639174600 | 01 | GA | NPI NUMBER | OTHER |