Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ME96937 | FL |
NPI | 1033217633 |
---|---|
Provider Name | Christina Marie Welch |
First Address | Moody Afb, GA 31699-1500 |
Second Address | Moody Afb, GA 31699-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |