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1225802168
MAXINE FOMUNUNG
DACULA, GA
NPI
1225802168
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: GA RN291792)
Enumeration Date
2023-11-10
Last Update Date
2024-12-04
Business Address
MAXINE FOMUNUNG
3206 THIMBLEBERRY TRL
DACULA, GA 30019-7299
Phone number: 470-461-3426
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Mailing Address
MAXINE FOMUNUNG
3206 THIMBLEBERRY TRL
DACULA, GA 30019-7299
Phone number: 470-461-3426
Copy
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