GRACE TAMU FOMUNUNG NURSE PRACTITIONER NPI 1679028575

NPI Information

NPI: 1679028575
Provider Name: GRACE TAMU FOMUNUNG, NURSE PRACTITIONER
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
3206 THIMBLEBERRY TRL
DACULA, GA
ZIP 30019
Phone: (404) 819-7338
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Grace Tamu Fomunung, NURSE PRACTITIONER is a psychiatric/mental health nurse practitioner in Dacula, GA. Grace Tamu Fomunung, NURSE PRACTITIONER NPI is 1679028575. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3206 THIMBLEBERRY TRL
DACULA, GA
ZIP 30019-299
Phone: (404) 819-7338

The NPI 1679028575 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/20/2016 and was last updated on 11/7/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163W00000X	Registered Nurse		RN201867	GEORGIA	No
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	RN201867	GEORGIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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