Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | RN130455 | GA |
NPI | 1104325828 |
---|---|
Provider Name | Mr. James Allan Carey |
First Address | Augusta, GA 30901-2603 |
Second Address | Augusta, GA 30912-0004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2018 |
Last Update Date | 29/03/2018 |