Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 182008 | GA |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 182008 | GA |
NPI | 1336698083 |
---|---|
Provider Name | James Lewis Osburn III |
First Address | Atlanta, GA 30308-2212 |
Second Address | Atlanta, GA 30308-2212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2016 |
Last Update Date | 09/09/2019 |