Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 036512 | GA |
NPI | 1013022029 |
---|---|
Provider Name | Dr. C Katherine Chance |
First Address | Augusta, GA 30901-5107 |
Second Address | Augusta, GA 30901-5107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 20/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00428425B | (05) | GA |
1988 | MCARE GRP (01) | GA |
G05379 | (02) |