Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN248311 | GA |
NPI | 1043864580 |
---|---|
Provider Name | Carli A Boatright |
First Address | Savannah, GA 31406-5216 |
Second Address | Savannah, GA 31404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2019 |
Last Update Date | 16/04/2020 |