Active NPI
Menlo Family Medicine, PC
- Family Nurse Practitioner
- Menlo, GA
National Provider Identifier
1154719623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- RN045044
- Legal business name
- MENLO FAMILY MEDICINE, PC
- Practice address
- 2968 Hwy 337
Menlo, GA 30731-0147 - Phone
- (706) 862-1717
- Fax
- (706) 862-1718
- NPI assigned
- Jan 6, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Connie Witt, FNP-C
- Title
- Owner
- Phone
- (706) 857-8692
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN045044 | GA | Primary |
Addresses
Primary practice location
2968 Hwy 337
Menlo, GA 30731-0147
Mailing address
PO Box 147
7TH Ave
Menlo, GA 30731-0147
Phone (706) 862-1717
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420502400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1420502400000",
"number": "1154719623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 147",
"address_2": "7TH AVE",
"city": "MENLO",
"state": "GA",
"postal_code": "307310147",
"telephone_number": "706-862-1717",
"fax_number": "706-862-1718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2968 HWY 337",
"city": "MENLO",
"state": "GA",
"postal_code": "307310147",
"telephone_number": "706-862-1717",
"fax_number": "706-862-1718"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MENLO FAMILY MEDICINE, PC",
"organizational_subpart": "NO",
"enumeration_date": "2015-01-06",
"last_updated": "2015-01-06",
"status": "A",
"authorized_official_last_name": "WITT",
"authorized_official_first_name": "CONNIE",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "706-857-8692",
"authorized_official_credential": "FNP-C"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "RN045044",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Menlo, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.