Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | DN013044 | GA |
Y | 1223X0400X | Orthodontists | DN013044 | GA |
NPI | 1427042480 |
---|---|
Provider Name | Dr. Julie K. Addis |
First Address | Dublin, GA 31021-5634 |
Second Address | Dublin, GA 31021-5634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 13/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
464844449A | (05) | GA |