Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN191947 | GA |
NPI | 1003179946 |
---|---|
Provider Name | Mary Allison Adams |
First Address | Atlanta, GA 30339-6151 |
Second Address | Commerce, GA 30529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2012 |
Last Update Date | 17/07/2018 |