Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | R128220 | GA |
NPI | 1487663886 |
---|---|
Provider Name | Mrs. Krista Marie Garner |
First Address | Loganville, GA 30052-2293 |
Second Address | Atlanta, GA 30322-1013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |