Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | RN190775 | GA |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN190775 | GA |
NPI | 1487048591 |
---|---|
Provider Name | Paige Gantt |
First Address | Lawrenceville, GA 30046-7694 |
Second Address | Lawrenceville, GA 30046-7694 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 15/10/2020 |