Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN220352 | GA |
NPI | 1023542925 |
---|---|
Provider Name | Mr. John Scarborough |
First Address | Kennesaw, GA 30152-2708 |
Second Address | Marietta, GA 30060-1160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2017 |
Last Update Date | 18/04/2017 |