Provider Demographics
NPI:1003297078
Name:RECORD, GENEVA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:GENEVA
Middle Name:MARIE
Last Name:RECORD
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:4700 BATTLEFIELD PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736
Mailing Address - Country:US
Mailing Address - Phone:706-861-4990
Mailing Address - Fax:706-861-9405
Practice Address - Street 1:4700 BATTLEFIELD PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736
Practice Address - Country:US
Practice Address - Phone:706-861-4990
Practice Address - Fax:706-861-9405
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN234548363LA2200X, 363LW0102X
GA234548363LW0102X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health