Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 000730 | GA |
NPI | 1194763292 |
---|---|
Provider Name | Dr. Delores Ann Combsbarnes |
First Address | Hoschton, GA 30548-6232 |
Second Address | Hoschton, GA 30548-6232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00615315A | (05) | GA |
U50447 | (02) | GA |