Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN243029 | GA |
NPI | 1013438597 |
---|---|
Provider Name | Lawrence Little III |
First Address | Atlanta, GA 30342-2807 |
Second Address | Atlanta, GA 30342-2807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2017 |
Last Update Date | 25/06/2021 |