Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 53464 | GA |
NPI | 1457401630 |
---|---|
Provider Name | Anita Johnson |
First Address | Canton, GA 30114-0250 |
Second Address | Woodstock, GA 30189-7062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 31/12/2009 |