Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN159185 NP | GA |
NPI | 1023121597 |
---|---|
Provider Name | Ms. Eileen Maccallum |
First Address | Alpharetta, GA 30005-4362 |
Second Address | Atlanta, GA 30322-4200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |