Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 183687 | GA |
NPI | 1013550508 |
---|---|
Provider Name | Ms. Monica Smart Mills |
First Address | Fairburn, GA 30213-4739 |
Second Address | Fairburn, GA 30213-4739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2019 |
Last Update Date | 28/10/2019 |