Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 277851 | GA |
NPI | 1023594199 |
---|---|
Provider Name | Rachel Awad |
First Address | Warner Robins, GA 31093-1505 |
Second Address | Warner Robins, GA 31093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2018 |
Last Update Date | 20/05/2019 |