Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN149725 NP | GA |
NPI | 1003130048 |
---|---|
Provider Name | Ashley Rae Gore |
First Address | Atlanta, GA 30309-1709 |
Second Address | Atlanta, GA 30309-1709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2010 |
Last Update Date | 19/08/2011 |