Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 60613 | GA |
Y | 2080P0204X | Pediatric Emergency Doctor | 60613 | GA |
NPI | 1265608681 |
---|---|
Provider Name | Amita Shroff |
First Address | Lawrenceville, GA 30046-7694 |
Second Address | Lawrenceville, GA 30046-7694 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2008 |
Last Update Date | 11/09/2013 |