Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT006920 | GA |
NPI | 1053484808 |
---|---|
Provider Name | Amy Atkinson Bernal |
First Address | Dacula, GA 30019-7415 |
Second Address | Dacula, GA 30019-7415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |