Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | TRN 21212 | FL |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 82883 | GA |
NPI | 1720467590 |
---|---|
Provider Name | Meredith Margaret Maxwell |
First Address | Tallahassee, FL 32308-4614 |
Second Address | Tallahassee, FL 32308-4614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2015 |
Last Update Date | 05/03/2020 |