Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Grace TAMU Fomunung, NURSEPRACTITIONER

Individual provider Registered Nurse · NPI 1679028575

Grace TAMU Fomunung, NURSEPRACTITIONER is a Nurse Practitioner in Dacula, Georgia. Qualified in 2019, 7 years ago. Accepts Medicare assignment and offers telehealth. Licensed in Georgia.

Years since qualifying
7
Licensed in
GA
In the registry since
2016
Specialties on file
2
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Practice location Address checks out

3206 Thimbleberry Trl
Dacula, GA 30019-7299
Phone: (404) 819-7338
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence RN201867 (GA)
Registered Nurse Taxonomy 163W00000X · Licence RN201867 (GA)

Record details

NPI number1679028575
Entity typeIndividual (Type 1)
GenderFemale
Credentials NURSEPRACTITIONER
Sole proprietorNo
NPI enumeratedAugust 20, 2016
Last updated in NPPESNovember 7, 2019

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Dacula