Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 070322 | GA |
NPI | 1003133091 |
---|---|
Provider Name | Dr. Elisa Jaramillo-Mayor |
First Address | Calhoun, GA 30703 |
Second Address | Calhoun, GA 30701-7016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2010 |
Last Update Date | 17/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003117022A | (05) | GA |