FARAH OCTAVIEN (NPI# 1629629613) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629629613 |
| Entity Type | Individual |
| Full Name | FARAH OCTAVIEN |
| Credential | AGNP |
| Practice Address |
2873 Village Park Dr E Ellenwood GA 30294-5712 |
| Practice Telephone | 6785710918 |
| Mailing Telephone | 6785710918 |
| Enumeration Date | 2019-09-22 |
| Last Update Date | 2019-09-22 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 364SG0600X |
Clinical Nurse Specialist Specialization: Gerontology |
AG03190021 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2873 VILLAGE PARK DR E |
| City | ELLENWOOD |
| State | GA |
| Zip Code | 30294-5712 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770124323 | Lula Varist Gholson | Counselor | Christian Counselor Ma Lou Gholson, 549 Lamar Drive, Forest Park, GA 30294 | 2019-10-04 |
| 1609428176 | Tykechia Todd | Ambulance | 3644 Caseys Cove, Ellenwood, GA 30294 | 2019-07-15 |
| 1891285243 | Ayana Aqila Thornton | Nurse Practitioner | 5654 Hosea Court, Ellenwood, GA 30294 | 2018-05-11 |
| 1346748837 | Kakethia S. Mack | Nurse Practitioner | 4124 Bosenberry Way, Ellenwood, GA 30294 | 2018-01-30 |
| 1851819312 | Tatiana Marcus | Prosthetist | 3895 Busby Mill Ct., Ellenwood, GA 30294 | 2017-09-05 |
| 1962944991 | Fairview Urgent Care, LLC | Clinic/Center | 4475 West Village Pkwy, Ellenwood, GA 30294 | 2016-11-08 |
| 1982006169 | Kristal Cure | Licensed Practical Nurse | 4057 Madiosn Court, Ellenwood, GA 30294 | 2014-09-19 |
| 1801233515 | 1st Class Learning and Performing Arts | Local Education Agency (LEA) | 5474 Platte Dr, Ellenwood, GA 30294 | 2013-06-04 |
| 1235480138 | Life Wellness Group of Atlanta | Home Delivered Meals | 145 Wilhemina Drive, Ellenwood, GA 30294 | 2012-10-02 |
| 1346548450 | William K Holley IIi | Counselor | 2732 Holly Berry Dr, Ellenwood, GA 30294 | 2011-03-14 |
| Find all providers in zip 30294 | ||||
| Taxonomy Code | 364SG0600X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Gerontology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225422231 | Kristina Waggoner | Clinical Nurse Specialist | 7430 Mckee Rd, Upatoi, GA 31829-1712 | 2015-03-27 |
| 1689810111 | Jackie Elizabeth Williams | Clinical Nurse Specialist | 4780 Ashford Dunwoody Rd, Suite A-266, Atlanta, GA 30338-5564 | 2009-01-06 |
| 1275784332 | Patricia R Harris | Clinical Nurse Specialist | 4780 Ashford Dunwoody Rd, Suite A-266, Atlanta, GA 30338-5564 | 2008-10-08 |
Please comment or provide details below to improve the information on FARAH OCTAVIEN.
| 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.