Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN170162 | GA |
NPI | 1043665243 |
---|---|
Provider Name | Mrs. Sara Hunlock Temple |
First Address | Hiram, GA 30141-1844 |
Second Address | Hiram, GA 30141-1844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2016 |
Last Update Date | 26/04/2016 |