Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | POD000786 | GA |
NPI | 1346324662 |
---|---|
Provider Name | Dr. Eileen Byrd |
First Address | Lawrenceville, GA 30046-3324 |
Second Address | Lawrenceville, GA 30046-4311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000739131F | (05) | GA |
U64359 | (02) |