Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | RN210121 | GA |
NPI | 1013467570 |
---|---|
Provider Name | Jill Morich Webb |
First Address | Stockbridge, GA 30281-6388 |
Second Address | Atlanta, GA 30338-6539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2016 |
Last Update Date | 17/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RN210121 | NP LICENSE (01) | GA |