Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN051308 | GA |
NPI | 1144479056 |
---|---|
Provider Name | Carol Pearson |
First Address | Columbus, GA 31901-1527 |
Second Address | Columbus, GA 31901-1527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2008 |
Last Update Date | 16/09/2008 |