Healthcare Provider Details

I. General information

NPI: 1548239643
Provider Name (Legal Business Name): GEORGIA LYNNE PERDUE DNP, CRNP-F
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 TIME SQ
SALISBURY MD
21801-2808
US

IV. Provider business mailing address

PO BOX 3177
SALISBURY MD
21802-3177
US

V. Phone/Fax

Practice location:
  • Phone: 410-548-2343
  • Fax: 844-332-3891
Mailing address:
  • Phone: 410-548-2343
  • Fax: 844-332-3891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR119543
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR119543
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: