Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 056582 | GA |
NPI | 1013921329 |
---|---|
Provider Name | Dr. Karuna Kusan |
First Address | Lawrenceville, GA 30043-5945 |
Second Address | Lawrenceville, GA 30043-5945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 23/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
356333517B | (05) | GA |
I38004 | (02) | GA |