Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN190105 | GA |
N | 363LG0600X | Nurse Practitioner - Gerontology | RN190105 | GA |
NPI | 1033777826 |
---|---|
Provider Name | Mrs. Jolly Maria Thomas |
First Address | Lawrenceville, GA 30043-3991 |
Second Address | Lawrenceville, GA 30043-3991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2019 |
Last Update Date | 05/06/2019 |