Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN235938 | GA |
NPI | 1003216102 |
---|---|
Provider Name | Christopher Pride |
First Address | Duluth, GA 30096-4959 |
Second Address | Duluth, GA 30096 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2014 |
Last Update Date | 14/06/2018 |