Costanzo, Erin R

Costanzo, Erin R is an individual health care provider with primary practice located at 7869 Villa Rica Hwy , Dallas GA 30157. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Costanzo, Erin R can be contacted via phone (770) 459-4411.

Contact Information

Primary practice address
7869 Villa Rica Hwy Dallas GA 30157
Phone: (770) 459-4411
Fax: (770) 459-2424
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X RN146776NP Georgia

Profile Details

NPI number 1649244997
LBN Legal business name Costanzo, Erin R
Credentials APRN FNPC
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2006
Last updated Jan 19th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649244997 NPPES
Georgia MEDICAID 453616500A
Georgia MEDICAID 453616500B

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