Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 043493 | GA |
NPI | 1164469193 |
---|---|
Provider Name | Dr. Janella Lynne Thomas-Burse |
First Address | Atlanta, GA 30331-8066 |
Second Address | College Park, GA 30349-5594 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
732174576A | (05) | GA |
G12915 | (02) | GA |