Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN229819 | GA |
NPI | 1265809883 |
---|---|
Provider Name | Sage Lauren Elmore |
First Address | Atlanta, GA 30308 |
Second Address | Atlanta, GA 30342-1764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2015 |
Last Update Date | 08/02/2019 |