Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | RN023116 | GA |
NPI | 1013191626 |
---|---|
Provider Name | Mrs. Margie Mizell James |
First Address | Waverly, GA 31565-2504 |
Second Address | Waverly, GA 31565-2504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2007 |
Last Update Date | 19/12/2007 |