Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN163859 | GA |
NPI | 1003202599 |
---|---|
Provider Name | Sharlene Maynor |
First Address | Riverdale, GA 30296-6921 |
Second Address | Riverdale, GA 30274-2634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2015 |
Last Update Date | 10/04/2015 |