Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN215630 | GA |
NPI | 1083122709 |
---|---|
Provider Name | Ashley Exum |
First Address | Lakeland, GA 31635-0603 |
Second Address | Lakeland, GA 31635-1011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2018 |
Last Update Date | 02/12/2019 |