Maxine Fomunung

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN291792 Issued in GA

Practice address

409 Old Boring LN
Woodstock, GA 30189-2495

Phone

(470) 461-3426

Fax

(770) 928-7558

NPI assigned

Nov 10, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cherokee Center for Change Counseling, Inc.

  • Professional Counselor
  • Woodstock, GA
  • NPI 1073892923
  NPD
• Cherokee Center for Change, Inc

  • Professional Counselor
  • Woodstock, GA
  • NPI 1285961466
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1699574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1225802168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3206 THIMBLEBERRY TRL",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300197299",
            "telephone_number": "470-461-3426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 OLD BORING LN",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301892495",
            "telephone_number": "470-461-3426",
            "fax_number": "770-928-7558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOMUNUNG",
        "first_name": "MAXINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-10",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN291792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Isabel Flores-Nieto
• Florida Autism Center
• Flow of Wellness LLC
• Timothy R. Flynn, M.D.
• Focus Counseling and Training, Inc.
• Food Lion, LLC
• Foot and Ankle Reconstruction of Georgia PC
• Foot and Ankle Reconstruction of North Georgia P.C
• John H Foote, MD
• Whitney Lauren Fose, MD

• Psychiatric/Mental Health Nurse Practitioner in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.