Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 61276 | GA |
N | 2080P0204X | Pediatric Emergency Doctor | A86246 | CA |
NPI | 1114011988 |
---|---|
Provider Name | Dr. Julia Easton Kaufman |
First Address | Mableton, GA 30126-7615 |
Second Address | Atlanta, GA 30328-5831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 03/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A862460 | (05) | CA |
I46009 | (02) | CA |