Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant | 180309 | GA |
NPI | 1891303913 |
---|---|
Provider Name | Courtney Walker |
First Address | Buford, GA 30519-5504 |
Second Address | Lawrenceville, GA 30046-9061 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2020 |
Last Update Date | 14/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
180309 | COA (01) | GA |