Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 29049 | GA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 29040 | GA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 29049 | GA |
NPI | 1801822978 |
---|---|
Provider Name | Diane L Mcgowan |
First Address | Lagrange, GA 30240 |
Second Address | Lagrange, GA 30240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E19913 | (02) |