Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 69523 | GA |
Y | 2080P0202X | Pediatric Cardiologist | 069523 | GA |
NPI | 1083930226 |
---|---|
Provider Name | Alice Hales-Kharazmi |
First Address | Atlanta, GA 30341-5540 |
Second Address | Atlanta, GA 30322-5540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2010 |
Last Update Date | 22/01/2021 |