Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN#235312 | GA |
NPI | 1023405800 |
---|---|
Provider Name | Mrs. Sarah Katharine Winter Thornbury |
First Address | Homewood, AL 35209-5202 |
Second Address | Columbus, GA 31901-1527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2015 |
Last Update Date | 20/04/2015 |