Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 11180 | GA |
Y | 111NI0900X | Internist | 11180 | GA |
NPI | 1003476433 |
---|---|
Provider Name | Dr. Anam Asif Herekar |
First Address | Augusta, GA 30912-0004 |
Second Address | Augusta, GA 30912-0004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2019 |
Last Update Date | 18/06/2019 |