Individual
MS. MARY GUMP FLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
1127 DRUID PARK AVE, AUGUSTA, GA 30904-5849
(706) 364-6485
Mailing address
1231 GLENN AVE, AUGUSTA, GA 30904-4615
(706) 736-1731
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN163789
GA
Other
Enumeration date
10/11/2006
Last updated
07/08/2007
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