Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156F00000X | Technician/Technologist |
NPI | 1295303477 |
---|---|
Provider Name | Brittany Monea Prince |
First Address | Statesboro, GA 30460-1360 |
Second Address | Statesboro, GA 30460-1360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2021 |
Last Update Date | 15/06/2021 |