Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | R077204 | GA |
NPI | 1104043405 |
---|---|
Provider Name | Karen G Manning |
First Address | Lagrange, GA 30240-3144 |
Second Address | Lagrange, GA 30240-3144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 25/01/2022 |