Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1548654411 |
---|---|
Provider Name | Donecia Perrin-Sullivan |
First Address | Martinez, GA 30907-1757 |
Second Address | Augusta, GA 30907-4751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2015 |
Last Update Date | 02/04/2020 |