Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN215955 | GA |
NPI | 1730664384 |
---|---|
Provider Name | Mr. Joshua Michael Kies |
First Address | Savannah, GA 31401-7526 |
Second Address | Savannah, GA 31401-7526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2018 |
Last Update Date | 05/10/2018 |