NPI | 1801402888 |
---|---|
Former Name | MEREDITH GAINES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9935) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: GA 9935) |
Enumeration Date | 2020-09-16 |
Last Update Date | 2024-07-08 |