Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | RN096387 | GA |
NPI | 1023069820 |
---|---|
Provider Name | Carol A Gourley |
First Address | Atlanta, GA 30322-1013 |
Second Address | Atlanta, GA 30308-2225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 08/07/2007 |