Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 46314 | GA |
NPI | 1093818312 |
---|---|
Provider Name | Lisa Kirkland |
First Address | Atlanta, GA 30303-1401 |
Second Address | Macon, GA 31217-3838 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 12/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
413046400 | (05) | MD |
413496600 | (05) | MD |