Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 028972 | GA |
NPI | 1083605281 |
---|---|
Provider Name | Ann E Eggert |
First Address | Peachtree City, GA 30269-1530 |
Second Address | Peachtree City, GA 30269-1530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 10/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000813689A | (05) | GA |