Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN214733 | GA |
NPI | 1003317090 |
---|---|
Provider Name | Addie B Gay |
First Address | Moultrie, GA 31768-5811 |
Second Address | Moultrie, GA 31768-5811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2018 |
Last Update Date | 24/02/2018 |