Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN148484 | GA |
NPI | 1033527924 |
---|---|
Provider Name | Kendaly Meadows |
First Address | Roswell, GA 30076 |
Second Address | Roswell, GA 30076-5829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2014 |
Last Update Date | 24/07/2014 |