Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN077228 | GA |
NPI | 1043380777 |
---|---|
Provider Name | Leslie Carol Mills |
First Address | Augusta, GA 30909-6481 |
Second Address | Augusta, GA 30909-6481 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 27/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00823611B | (05) | GA |