Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN216616 | GA |
NPI | 1083104608 |
---|---|
Provider Name | Mrs. Jillian Long Mcgee |
First Address | Marietta, GA 30064-5279 |
Second Address | Austell, GA 30106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2018 |
Last Update Date | 08/06/2018 |