Individual
BENTLEY ELIZABETH KNOX MAIAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1205 US HIGHWAY 19 S, LEESBURG, GA 31763-4878
(229) 759-7028
Mailing address
2210 HOLLY SPRINGS PKWY UNIT 1305, HOLLY SPRINGS, GA 30142-1760
(770) 990-7382
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN249087
GA
Other
Enumeration date
01/27/2020
Last updated
06/09/2024
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