Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1346743622 |
---|---|
Provider Name | Dr. Celeste Grace Adote |
First Address | Woodstock, GA 30188-4576 |
Second Address | Woodstock, GA 30188-4846 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2018 |
Last Update Date | 13/03/2018 |