Individual
MRS. SHIRLEY MIKE OATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CERTIFIED PEDIATRIC
Contact information
Practice address
414 LUGENIA BLVD, VIDALIA, GA 30474
(912) 537-9355
(912) 537-7038
Mailing address
PO BOX 569, 414 LUGENIA BLVD, VIDALIA, GA 30475
(912) 537-9355
(912) 537-7038
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN115236
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00692392C
—
GA
Enumeration date
10/18/2006
Last updated
07/08/2007
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