Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 197237 | GA |
NPI | 1013309327 |
---|---|
Provider Name | Amber Borders |
First Address | Austell, GA 30106-1151 |
Second Address | Austell, GA 30106-1151 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2015 |
Last Update Date | 14/01/2016 |