Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 63930 | GA |
NPI | 1437316114 |
---|---|
Provider Name | Dr. Katherine Elizabeth Nicholson |
First Address | Atlanta, GA 30342-1605 |
Second Address | Atlanta, GA 30342-1605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2008 |
Last Update Date | 10/06/2010 |