REBECCA FONDREN HUMPHRIES (NPI# 1467606293) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467606293 |
| Entity Type | Individual |
| Full Name | REBECCA FONDREN HUMPHRIES |
| Credential | APRN |
| Practice Address |
303 Smith Street Emory Clark Holder Clinic Lagrange GA 30240 |
| Practice Telephone | 7068828831 |
| Practice Fax Number | 7068124091 |
| Mailing Telephone | 7068828831 |
| Mailing Fax Number | 7068124091 |
| Enumeration Date | 2008-11-06 |
| Last Update Date | 2008-11-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | RN175845 NP | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
RN175845 NP | GA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
RN175845 NP | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
303 SMITH STREET EMORY CLARK HOLDER CLINIC |
| City | LAGRANGE |
| State | GA |
| Zip Code | 30240 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639114895 | John Connor Smith | Urology | 303 Smith Street, Clark-holder Clinic, P.a., Lagrange, GA 30240 | 2006-06-19 |
| 1679924427 | Christina Noles Thornton | Nurse Practitioner | 303 Smith Street, Emory Clark- Holder Clinic, Lagrange, GA 30240 | 2016-06-23 |
| 1982952131 | Wendy Taylor | Nurse Practitioner | 303 Smith Street, Lagrange, GA 30240 | 2012-08-20 |
| 1487981312 | Dana Lynn Brooks | Nurse Practitioner | 303 Smith Street, Emory Clark-holder Clinic, Lagrange, GA 30240 | 2009-11-13 |
| 1902842263 | Candace H Wortham | Nurse Practitioner | 303 Smith Street, Clark-holder Clinic, P.a., Lagrange, GA 30240 | 2006-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598223844 | Urgencare, LLC | Clinic/Center | 2169 West Point Road, Suite 105, Lagrange, GA 30240 | 2019-03-06 |
| 1679075527 | Georgia Pain and Spine Care, Inc | Pain Medicine | 303 Smith St Fl 2, Lagrange, GA 30240 | 2018-03-07 |
| 1629463500 | Quoc Vinh Ngo | Emergency Medicine | Wellstar West Georgia Medical Center, 1504 Vernon Road, Lagrange, GA 30240 | 2015-03-30 |
| 1770913964 | Dell H Lawson | Counselor | 300 Medical Dr. Ste 705., Lagrange, GA 30240 | 2013-11-25 |
| 1629418793 | Mortar & Pestle, LLC | Pharmacy | 205 Vernon Street, Lagrange, GA 30240 | 2013-07-03 |
| 1336582329 | Weredeselam Menna Olango | Psychiatry & Neurology | 303 Medical Dr Ste 401, Lagrange, GA 30240 | 2013-04-10 |
| 1720333743 | Mortar and Pestle, LLC | Pharmacy | 300 Mooty Bridge Road, Lagrange, GA 30240 | 2012-07-16 |
| 1366768459 | Karin Taylor | Physical Medicine & Rehabilitation | 1600 Vernon Rd Ste A, Lagrange, GA 30240 | 2010-04-14 |
| 1871819458 | Kathryn J Hill | Counselor | 100 Smith St Ste 1, Lagrange, GA 30240 | 2010-04-08 |
| 1285802751 | Air Evac Ems, Inc. | Ambulance | 455 Aerotron Pkwy, Lagrange, GA 30240 | 2008-02-18 |
| Find all providers in zip 30240 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902342835 | Taylor Jones Moss | Nurse Practitioner | 1514 Vernon Rd, Lagrange, GA 30240-4131 | 2017-01-17 |
| 1508802166 | Serena M Coulombe | Nurse Practitioner | Clark-holder Clinic, P.a., 303 Smith Street, Lagrange, GA 30240 | 2006-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154110 | Christina Danielle Palau Vaccari | Nurse Practitioner | 712 Pasley Ave Se, Atlanta, GA 30316-2158 | 2020-11-07 |
| 1427657113 | Cynthia Diane Prather | Nurse Practitioner | 3264 Lower Boston Rd, Thomasville, GA 31757-1311 | 2020-10-22 |
| 1932706728 | Alecia Ann Czarnecki | Nurse Practitioner | 6240 Crooked Creek Dr, Rex, GA 30273-5006 | 2020-10-05 |
| 1801401112 | Cotenna D. Clark | Nurse Practitioner | 1857 Cameo Ct, Tucker, GA 30084-7002 | 2020-09-14 |
| 1487264370 | Helen Young Yates | Nurse Practitioner | 40 Red Rock Ct Ne, Ludowici, GA 31316-6280 | 2020-08-05 |
| 1982214334 | Jasmine Alecia Henderson | Nurse Practitioner | 52 Roseberry Cir, Port Wentworth, GA 31407-5612 | 2020-07-31 |
| 1275142994 | Theresia Richardson | Nurse Practitioner | 2033 Buford Hwy Ste 109, Buford, GA 30518-8802 | 2020-07-28 |
| 1063021277 | Elsa Duncan Duncan | Nurse Practitioner | 1822 E Gwinnett St, Savannah, GA 31404-1853 | 2020-07-24 |
| 1154941946 | Joy P Wharton | Nurse Practitioner | 182 Silver Arrow Cir, Austell, GA 30168-7490 | 2020-04-21 |
| 1235769985 | Michelle Brack | Nurse Practitioner | 502 Hall Rd, Thomasville, GA 31757-8105 | 2020-01-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.