Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 011906 | GA |
NPI | 1003099375 |
---|---|
Provider Name | Dr. Alisa Jeannette Raglin |
First Address | Atlanta, GA 30311-3121 |
Second Address | Atlanta, GA 30311-3121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2007 |
Last Update Date | 10/12/2007 |