Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CO088832 | GA |
NPI | 1194221663 |
---|---|
Provider Name | Angela Slade |
First Address | Atlanta, GA 30319-1275 |
Second Address | Atlanta, GA 30319-1275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2018 |
Last Update Date | 03/04/2018 |