Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN209269 | GA |
NPI | 1598136814 |
---|---|
Provider Name | Jodi Holland |
First Address | Marietta, GA 30060 |
Second Address | Marietta, GA 30060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2015 |
Last Update Date | 13/10/2015 |