Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | AT002098 | GA |
NPI | 1700350121 |
---|---|
Provider Name | Mrs. Hope Price |
First Address | Statesboro, GA 30458-2464 |
Second Address | Statesboro, GA 30458-2464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2019 |
Last Update Date | 18/01/2019 |