Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 032990 | GA |
NPI | 1033118146 |
---|---|
Provider Name | Dr. Judith Lila Silverstein |
First Address | Roswell, GA 30076-1143 |
Second Address | Roswell, GA 30076-1143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 02/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C 34540 | (02) | GA |