Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 058803 | GA |
N | 207RP1001X | Pulmonary Disease | 058803 | GA |
NPI | 1356492094 |
---|---|
Provider Name | Barbara Jean Mroz |
First Address | Marietta, GA 30066-6340 |
Second Address | Austell, GA 30106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 31/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F16879 | (02) | PA |