Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | RN036923 | GA |
NPI | 1104991629 |
---|---|
Provider Name | Mrs. Juanita Battle |
First Address | Americus, GA 31709-3737 |
Second Address | Americus, GA 31709-3737 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 17/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000467651H | (05) | GA |
00467651B | (05) | GA |