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MAXINE FOMUNUNG
NPI 1225802168
Nurse Practitioner - Psychiatric/Mental Health in Woodstock, GA

Active since November 10, 2023
409 OLD BORING LN, WOODSTOCK, GA 30189(470) 461-3426(770) 928-7558 Get Directions Write a Review

NPPES record last updated: March 18, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 18, 2025, Dec 4, 2024, Nov 10, 2023 (3 updates tracked since 2023).

About Maxine Fomunung NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAXINE FOMUNUNG (NPI 1225802168) is an individual psychiatric/mental health provider in Woodstock, Georgia, licensed in Georgia (RN291792) and active in the NPI registry since November 2023.

NPPES Registry Identity

NPI1225802168
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameMAXINE FOMUNUNG
Location Address409 OLD BORING LNWoodstock, GA 30189-2495
Mailing Address3206 Thimbleberry TrlDacula, GA 30019-7299 · (470) 461-3426
Phone(470) 461-3426
Fax(770) 928-7558
Sole ProprietorYes
Enumeration DateNovember 10, 2023
Last NPPES UpdateMarch 18, 20253 updates tracked since enumeration
NPPES CertifiedMarch 18, 2025
✔ NPI 1225802168 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in GA · RN291792
409 OLD BORING LN, Woodstock, GA 30189
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Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. LILY GAYLOR MOORE-COLL LAPC
Counselor (Professional)
409 OLD BORING LN
WOODSTOCK, GA 30189
Cherokee County (770) 928-7300
BRIANNA WISEMAN LPC
Counselor (Professional)
409 OLD BORING LN
WOODSTOCK, GA 30189
Cherokee County (770) 928-7300
BRENDA NORTON HALL LPC
Counselor (Professional)
409 OLD BORING LN
WOODSTOCK, GA 30189
Cherokee County (770) 928-7300
JERRY WAYNE COX
Counselor (Professional)
409 OLD BORING LN
WOODSTOCK, GA 30189
Cherokee County (770) 928-7300
WHITNEY P. MORBERG LPC
Counselor (Professional)
409 OLD BORING LN
WOODSTOCK, GA 30189
Cherokee County (770) 928-7300
CHEROKEE CENTER FOR CHANGE, INC
Counselor (Professional)
409 OLD BORING LN
WOODSTOCK, GA 30189
Cherokee County (770) 928-7300
ELIZABETH SHAW LCSW
Social Worker (Clinical)
409 OLD BORING LN
WOODSTOCK, GA 30189
Cherokee County (770) 928-7300
JODI GIULIANO LAPC, NCC
Counselor
409 OLD BORING LN
WOODSTOCK, GA 30189
Cherokee County (770) 928-7300

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Maxine Fomunung's NPI number?

The NPI number for Maxine Fomunung is 1225802168. It was assigned to this individual provider in the NPPES registry on November 10, 2023.

Where is Maxine Fomunung located?

Maxine Fomunung practices at 409 Old Boring Ln, Woodstock, GA 30189. The listed phone number is (470) 461-3426.

What is Maxine Fomunung's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

When was this NPI record last updated?

The NPPES record for Maxine Fomunung was last updated on March 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.