Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN120409 | GA |
NPI | 1003035734 |
---|---|
Provider Name | Ms. Susan Gail Adams |
First Address | Athens, GA 30605-4637 |
Second Address | Athens, GA 30605-3625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |