Provider Demographics
NPI:1447333471
Name:ROSS, ANITA M (FNP)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:M
Last Name:ROSS
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Gender:F
Credentials:FNP
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Mailing Address - Street 1:117 KITE RD
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-3231
Mailing Address - Country:US
Mailing Address - Phone:478-289-1303
Mailing Address - Fax:478-289-7466
Practice Address - Street 1:110 NORMAN DORMINY DR STE A
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8858
Practice Address - Country:US
Practice Address - Phone:229-409-0874
Practice Address - Fax:229-424-7392
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2018-08-16
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Provider Licenses
StateLicense IDTaxonomies
GARN102271 NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA554945714AMedicaid