Doctor Name: | GENTRY BROACH TOLBERT |
NPI Number: | 1144517038 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | N.P. |
License Number: | RN175489 |
Business Practice Address: | 1500 Langford Medical Drive Bldg 200 Bogart, GA - 30622 |
Business Phone Number: | 7062080451 |
Business Fax Number: | |
Mailing Address: | 1500 Langford Medical Drive, Bldg 200 BOGART |
State: | GA |
Postal Code: | 30622 |
Phone Number: | 7062080451 |
Fax Number: | |
NPI Enumeration Date: | 06/30/2011 |
NPI Last Update Date: | 06/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN175489 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |