Key: = 1  This state's regular session is adjourned for 2016. = 2  This state's legislature is in regular session. = 3  This state's legislature is in recess. =  Special 1  session. = No regular session scheduled in 2016. =  This state's legislature was in a session that was not a regular or special session.
NPI Number: 1215096029: Entity Type Code: Individual: Provider Name (Legal Business Name): PATRICE BARNUM MD: Provider Business Mailing Address: First Line: 8511 S SAM HOUSTON PKWY E: Second Line : SUITE 101: City :
Student Signature Date. See the back of this form for immunization requirements and acceptable documentation. Return documentation to Georgia Gwinnett College, Admissions Office, 1000 University Center Lane, Lawrenceville, GA 30043, or fax to: 678-407-5747.