Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 051459 | GA |
NPI | 1124026190 |
---|---|
Provider Name | Dr. Karen Dudley |
First Address | Atlanta, GA 30328-5382 |
Second Address | Atlanta, GA 30328-5382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 12/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000948659B | (05) | GA |
000948659C | (05) | GA |
461337212A | (05) | GA |