Basic Information
| Provider Information | |||||||||
| NPI: | 1003297078 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RECORD | ||||||||
| FirstName: | GENEVA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 BATTLEFIELD PARKWAY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | RINGGOLD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068614990 | ||||||||
| FaxNumber: | 7068619405 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 BATTLEFIELD PARKWAY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | RINGGOLD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068614990 | ||||||||
| FaxNumber: | 7068619405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2015 | ||||||||
| LastUpdateDate: | 07/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | RN234548 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LW0102X | RN234548 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363LW0102X | 234548 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363LA2200X | 234548 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.