Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN120898 | GA |
NPI | 1235560921 |
---|---|
Provider Name | Jeannie King |
First Address | Rome, GA 30161-3209 |
Second Address | Rome, GA 30165-5621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2013 |
Last Update Date | 29/03/2021 |