Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | RN180727 | GA |
NPI | 1073902094 |
---|---|
Provider Name | Veronica Eberhart |
First Address | Atlanta, GA 30374-2616 |
Second Address | Braselton, GA 30517-5600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2015 |
Last Update Date | 09/11/2020 |