| Doctor Name: | GENEVA MARIE RECORD |
| NPI Number: | 1003297078 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 234548 |
| Business Practice Address: | 4700 Battlefield Parkway Suite 200 Ringgold, GA - 30736 |
| Business Phone Number: | 7068614990 |
| Business Fax Number: | 7068619405 |
| Mailing Address: | 4700 Battlefield Parkway, Suite 200 RINGGOLD |
| State: | GA |
| Postal Code: | 30736 |
| Phone Number: | 7068614990 |
| Fax Number: | 7068619405 |
| NPI Enumeration Date: | 06/15/2015 |
| NPI Last Update Date: | 07/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 234548 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |