JOSEPH VINCENT BAUTISTA DOROMAL (NPI# 1891286928) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891286928 |
| Entity Type | Individual |
| Full Name | JOSEPH VINCENT BAUTISTA DOROMAL |
| Credential | NP |
| Practice Address |
111 Mountain Brook Dr Canton GA 30115-9045 |
| Practice Telephone | 6788809654 |
| Mailing Telephone | 6788809654 |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2018-05-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | RN240795 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
111 MOUNTAIN BROOK DR |
| City | CANTON |
| State | GA |
| Zip Code | 30115-9045 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740894690 | Maria Lezcano Tommolino | Nurse Practitioner | 111 Mountain Brook Dr, Canton, GA 30115-9045 | 2020-09-08 |
| 1578104170 | Mary Katherine Thrash White | Pediatrics | 111 Mountain Brook Dr, Canton, GA 30115-9045 | 2019-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497364806 | Amanda Arbogast | Speech-Language Pathologist | 610 Royal Crest Court, Canton, GA 30115 | 2020-07-31 |
| 1033754163 | Kelly Marie Shirley | Nurse Practitioner | 450 Northside Cherokee Blvd., Radiology Dept., Canton, GA 30115 | 2019-11-13 |
| 1700394319 | Jennifer Lynn Davenport | Nurse Practitioner | 684 Sixes Rd Ste 125, Holly Springs, GA 30115 | 2018-01-17 |
| 1851717961 | Wal-mart Stores East, Lp | Technician/Technologist | 2200 Holly Springs Pkey, Holly Springs, GA 30115 | 2014-03-13 |
| 1194148502 | Julia Bedingfield Reid | Pharmacist | 450 Northside Cherokee Blvd Ste T20, Canton, GA 30115 | 2014-01-22 |
| 1447597992 | America's Best Contacts & Eyeglasses | Technician/Technologist | 2030 Cumming Highway, Suite 106, Canton, GA 30115 | 2013-01-03 |
| 1679821193 | Jill M Decorso | Speech-Language Pathologist | 4280 Hickory Flat Hwy, Ste 108, Canton, GA 30115 | 2012-08-15 |
| 1306113378 | Sidney Boyd Collier IIi | Pharmacist | 6111 Hickory Flat Highway, Canton, GA 30115 | 2011-11-18 |
| 1174804702 | Rayllensons Itacy | Physician Assistant | 2020 Cumming Highway, Suite 102, Canton, GA 30115 | 2011-09-09 |
| 1245534346 | Kim M. Mcmillan | Counselor | 154 Lakeside Drive, Canton, GA 30115 | 2011-01-04 |
| Find all providers in zip 30115 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033754163 | Kelly Marie Shirley | Nurse Practitioner | 450 Northside Cherokee Blvd., Radiology Dept., Canton, GA 30115 | 2019-11-13 |
| 1245748060 | Renita Roychelle Strickland | Nurse Practitioner | 498 Chattin Dr, Canton, GA 30115-8240 | 2018-01-15 |
| 1487176921 | Nguyet Tran Tyler | Nurse Practitioner | 1558 Riverstone Pkwy, Canton, GA 30114-2898 | 2017-07-15 |
| 1255865820 | Mercedita Ungab-canete | Nurse Practitioner | 4019 Sarah Ann Dr, Canton, MI 48188-2193 | 2017-04-20 |
| 1720447477 | Shafiq U Rehman | Nurse Practitioner | 41667 Quail Ct, Canton, MI 48188-5228 | 2016-02-22 |
| 1396119145 | Marie Posy | Nurse Practitioner | 506 Blue Mountain Rise, Canton, GA 30114-5713 | 2015-11-17 |
| 1407231202 | Advanced Wound and Ostomy Solutions | Nurse Practitioner | 203 River Green Ave, Canton, GA 30114-5846 | 2015-07-22 |
| 1427474527 | Stephen Collins | Nurse Practitioner | 1684 Fallen Timber St Ne, Canton, OH 44721-3858 | 2014-03-13 |
| 1992030712 | Cheryl Lynn Belopotosky | Nurse Practitioner | 733 Market Ave. Sw, Canton, OH 44702-1018 | 2009-10-13 |
| 1568515377 | Kathy Kise | Nurse Practitioner | 49650 Cherry Hill Rd Ste 220, Canton, MI 48187-4860 | 2007-01-18 |
| Find all providers in CANTON | ||||
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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.