Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN107078NP | GA |
NPI | 1366449035 |
---|---|
Provider Name | Ms. Carlota E Perrot |
First Address | Atlanta, GA 30322-1059 |
Second Address | Atlanta, GA 30322-2467 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 20/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RN107078NP | GA NURSE PRACT LICENSE # (01) | GA |