Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 040886 | GA |
NPI | 1316026792 |
---|---|
Provider Name | Dr. Grace Chin Yut |
First Address | Columbus, GA 31904-2947 |
Second Address | Columbus, GA 31904-8725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040886 | STATE LICENCE (01) | GA |