Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 074196 | GA |
NPI | 1023301660 |
---|---|
Provider Name | Amy Reed Goss |
First Address | Carrollton, GA 30117-3857 |
Second Address | Carrollton, GA 30117-3862 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2011 |
Last Update Date | 19/11/2015 |