Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | CNM04840 | GA |
NPI | 1043709579 |
---|---|
Provider Name | Marissa Storms |
First Address | Atlanta, GA 30312-1695 |
Second Address | Atlanta, GA 30342-1554 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2018 |
Last Update Date | 10/05/2018 |