Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 2607 | GA |
NPI | 1356999130 |
---|---|
Provider Name | Anna Mccaskill |
First Address | Dacula, GA 30019-7771 |
Second Address | Dacula, GA 30019-7771 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2019 |
Last Update Date | 26/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
842706523 | (05) | GA |