Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | 051301 | GA |
Y | 208D00000X | General Practice Physician | 053101 | GA |
NPI | 1184673774 |
---|---|
Provider Name | Gillian A Carpenter |
First Address | Flowery Branch, GA 30542-2754 |
Second Address | Flowery Branch, GA 30542-2754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 25/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000973398B | (05) | GA |
F10799 | (02) |