Most Relevant Information
Provider Data
| NPI Number: | 1003488958 |
| Provider Name: | IRETA FAVORS PMHNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0808X |
| Specialty: | Nurse Practitioner |
| License Number: | RN296873 |
Most Important Dates
| Enumeration Date: | 07/12/2021 |
| Last Updated: | 02/20/2024 |
Provider Practice Location
250 BRAY ST
ATHENS
GA
306012203
Practice Location Phone/Fax
| Phone: | 6782154907 |
| Fax: | 6786718489 |
Provider Mailing Location
1575 LAWRENCEVILLE HWY STE K
LAWRENCEVILLE
GA
300442007
Provider Mailing Phone/Fax
| Phone: | 6782154907 |
| Fax: | 6786718489 |