Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 001522 | GA |
NPI | 1013034453 |
---|---|
Provider Name | Agnes Adu |
First Address | Sugar Hill, GA 30518-5697 |
Second Address | Sugar Hill, GA 30518-5697 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |