Individual
MRS. JOLLY MARIA THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1867 ANTHONY NANE CT, LAWRENCEVILLE, GA 30043-3991
(404) 213-3698
Mailing address
1867 ANTHONY NANE CT, LAWRENCEVILLE, GA 30043-3991
(404) 213-3698
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN190105
GA
363LG0600X
Gerontology Nurse Practitioner
RN190105
GA
Other
Enumeration date
06/05/2019
Last updated
06/05/2019
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