Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 000000000000 | GA |
NPI | 1013500073 |
---|---|
Provider Name | Mrs. Santoria Gibbs Hambolu |
First Address | Montgomery, AL 36117-3227 |
Second Address | Atlanta, GA 30322-1059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2021 |
Last Update Date | 19/02/2021 |