Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN183592 | GA |
NPI | 1003454687 |
---|---|
Provider Name | Mrs. Katherine Elaine Campbell Thomas |
First Address | Lawrenceville, GA 30043-7245 |
Second Address | Lawrenceville, GA 30046-7694 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2019 |
Last Update Date | 18/12/2019 |