Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | GA |
NPI | 1659496537 |
---|---|
Provider Name | Dr. Catherine Isabelle Mickler |
First Address | Valdosta, GA 31601-7527 |
Second Address | Valdosta, GA 31601-7527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |