Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 71684 | GA |
N | 2080P0210X | Pediatric Nephrologist | 71684 | GA |
NPI | 1760773022 |
---|---|
Provider Name | Alana Meryll Bozeman |
First Address | Lawrenceville, GA 30046 |
Second Address | Lawrenceville, GA 30046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2011 |
Last Update Date | 14/07/2017 |