Domville, Mary M
Domville, Mary M is an individual health care provider with primary practice located at 524 Dixie St , Carrollton GA 30117-3805. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Domville, Mary M can be contacted via phone (770) 832-2775.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 003494 | Georgia |
Profile Details
| NPI number | 1578573820 |
|---|---|
| LBN Legal business name | Domville, Mary M |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 9th, 2006 |
| Last updated | Feb 13th, 2009 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578573820 | NPPES |
| Georgia | Other | 003494 | STATE LICENSE |
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