Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN193221 | GA |
N | 363LA2100X | Nurse Practitioner - Acute Care | RN193221 | GA |
N | 363LA2200X | Nurse Practitioner - Adult Health | RN193221 | GA |
NPI | 1003280975 |
---|---|
Provider Name | Ms. Charvette Gaitone Shumaker-Kirk |
First Address | Newnan, GA 30265-8001 |
Second Address | Newnan, GA 30265-8001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2015 |
Last Update Date | 24/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003173092B | (05) | GA |