Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 61058433 | WA |
NPI | 1275093973 |
---|---|
Provider Name | Dr. Elizabeth Grace Knoff Floodeen |
First Address | Augusta, GA 30912 |
Second Address | Augusta, GA 30912-1270 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2019 |
Last Update Date | 25/03/2021 |