Provider Demographics
NPI:1548239643
Name:PERDUE, GEORGIA LYNNE (DNP, CRNP-F)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:LYNNE
Last Name:PERDUE
Suffix:
Gender:F
Credentials:DNP, CRNP-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3177
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-3177
Mailing Address - Country:US
Mailing Address - Phone:410-548-2343
Mailing Address - Fax:844-332-3891
Practice Address - Street 1:105 TIME SQ
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2808
Practice Address - Country:US
Practice Address - Phone:410-548-2343
Practice Address - Fax:844-332-3891
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR119543363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412302600Medicaid