Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | AP07779 | LA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 258990 | GA |
NPI | 1093107799 |
---|---|
Provider Name | Anjhari Matthews |
First Address | Palmetto, GA 30268-1138 |
Second Address | Carrollton, GA 30117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2015 |
Last Update Date | 05/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003204866A | (05) | GA |