Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | F625 | SC |
NPI | 1023238748 |
---|---|
Provider Name | Mrs. Carolyn Birchmore |
First Address | Atlanta, GA 30384-2145 |
Second Address | Lexington, SC 29072-7653 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 02/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AA8494A871 | MEDICARE PTAN (01) | SC |
NP0216 | (05) | SC |