Grace Tamu Fomunung, NURSE PRACTITIONER

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN201867 Issued in GA

Practice address

3206 Thimbleberry TRL
Dacula, GA 30019-7299

Phone

(404) 819-7338

NPI assigned

Aug 20, 2016

Last updated

Nov 7, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Grace Carothers Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jehovahs Behavioral Care LLC

  dba Grace Fomunung Sole MBR

  • Psychiatric/Mental Health Nurse Practitioner
  • Dacula, GA
  • NPI 1619612876
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1471651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573084800000",
    "number": "1679028575",
    "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": "404-819-7338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3206 THIMBLEBERRY TRL",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300197299",
            "telephone_number": "404-819-7338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOMUNUNG",
        "first_name": "GRACE",
        "middle_name": "TAMU",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-20",
        "last_updated": "2019-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN201867",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN201867",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRACE",
            "last_name": "CAROTHERS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Yearim Kim Flores, DMD
• Joann Denise Flot Lindsey, NP
• Tonia Flowers, RN
• Holly Foard
• Caitlin Fockele, PT, DPT
• Victoria Fong
• Oslyn Forbes, NP
• Julia Forrester, OTR/L
• Fostering Resilience LLC
• Foundations Pediatric Speech Therapy Services LLC

• Psychiatric/Mental Health Nurse Practitioner in Dacula, GA
• Providers in Dacula, 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 Nov 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.