Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 053407 | GA |
NPI | 1013922558 |
---|---|
Provider Name | Amie Elizabeth Squires |
First Address | Evans, GA 30809-4274 |
Second Address | Augusta, GA 30904-6258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |