Individual
MRS. MARY KOPP GIDDENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, APRN
Contact information
Practice address
2538 OLD HOLTON RD, MACON, GA 31204-1729
(478) 731-0385
Mailing address
2538 OLD HOLTON RD, MACON, GA 31204-1729
(478) 731-0385
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
RN183848
GA
363LP0200X
Pediatric Nurse Practitioner
Primary
RN183848
GA
Other
Enumeration date
06/26/2018
Last updated
01/07/2019
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