Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN171151 | GA |
NPI | 1013146331 |
---|---|
Provider Name | Caroline Mccoy |
First Address | Atlanta, GA 30309-1281 |
Second Address | Atlanta, GA 30309-1281 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2009 |
Last Update Date | 08/07/2009 |