Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | RN195027 | GA |
NPI | 1013998871 |
---|---|
Provider Name | Ms. Laura Redden |
First Address | Sandersville, GA 31082-1863 |
Second Address | Sandersville, GA 31082-1863 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 12/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P44727 | (02) |