Provider Demographics
NPI:1790190817
Name:EARL, ADRIENNE KATHLEEN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:KATHLEEN
Last Name:EARL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 3RD ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3294
Mailing Address - Country:US
Mailing Address - Phone:478-464-2600
Mailing Address - Fax:478-474-1043
Practice Address - Street 1:610 3RD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3294
Practice Address - Country:US
Practice Address - Phone:478-464-2600
Practice Address - Fax:478-474-1043
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN186685363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily