Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN232793 | GA |
NPI | 1205342409 |
---|---|
Provider Name | Michael G Jump |
First Address | Albany, GA 31701-1900 |
Second Address | Albany, GA 31701-1943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2017 |
Last Update Date | 26/12/2017 |