Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DN015060 | GA |
NPI | 1124315965 |
---|---|
Provider Name | Dr. Aundrea Vereen Eady |
First Address | Decatur, GA 30035-3903 |
Second Address | Decatur, GA 30035-3903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2011 |
Last Update Date | 16/04/2020 |