Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 18434 | TN |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN211420 | GA |
NPI | 1003231416 |
---|---|
Provider Name | Mrs. Jessica Sanders |
First Address | Chatsworth, GA 30705-4008 |
Second Address | Chatsworth, GA 30705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2014 |
Last Update Date | 24/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003187642 | (05) | GA |