Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | RN171722 | GA |
NPI | 1083154975 |
---|---|
Provider Name | Julia Varghese I |
First Address | Atlanta, GA 30374-2616 |
Second Address | Gainesville, GA 30501-3715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2017 |
Last Update Date | 07/12/2020 |