Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CHIR007222 | GA |
NPI | 1285629253 |
---|---|
Provider Name | Dr. Cedrick Christopher Noel |
First Address | Roswell, GA 30075-5813 |
Second Address | Roswell, GA 30075-5812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 08/07/2007 |