Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 047339 | GA |
NPI | 1013092733 |
---|---|
Provider Name | Christine D Lallos |
First Address | Atlanta, GA 30374-2616 |
Second Address | Gainesville, GA 30501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 12/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000878622A | (05) | GA |
H23415 | (02) |