Individual
MARY BETH BRUNER THARP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
85 JOHN MADDOX DRIVE CONNECTOR NW, ROME, GA 30165-1233
(762) 235-2990
(706) 238-8031
Mailing address
221 TECHNOLOGY PKWY NW, ROME, GA 30165-1369
(762) 235-1000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN104841
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000706373E
—
GA
Enumeration date
01/12/2007
Last updated
07/21/2020
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