Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN289437 | GA |
NPI | 1174176382 |
---|---|
Provider Name | Miss Acenith Garvey |
First Address | Fairburn, GA 30213-6067 |
Second Address | Atlanta, GA 30308-2212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2019 |
Last Update Date | 21/07/2020 |