Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | RN205936 | GA |
Y | 363L00000X | Nurse Practitioner | NCO-000003 | GA |
NPI | 1215471479 |
---|---|
Provider Name | Deana Perkins |
First Address | Thomaston, GA 30286-5004 |
Second Address | Thomaston, GA 30286-5004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2016 |
Last Update Date | 19/10/2020 |