Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0101X | MOHS-Micrographic Surgeon | 050005 | GA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | P50005 | GA |
NPI | 1124137351 |
---|---|
Provider Name | Dr. Katarina Gabrielle Lequeux-Nalovic |
First Address | Atlanta, GA 30305-1578 |
Second Address | Atlanta, GA 30305-1578 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 16/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H37280 | (02) | |
H37280 | (02) | GA |
P00001415 | RR MEDICARE (01) | GA |