Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 156449 | GA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 156449 | GA |
N | 363LP2300X | Nurse Practitioner - Primary Care | RN156449 | GA |
NPI | 1538710702 |
---|---|
Provider Name | Patience Mayo |
First Address | Douglasville, GA 30133-1563 |
Second Address | Douglasville, GA 30135-1739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2019 |
Last Update Date | 22/12/2019 |