Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 77507 | GA |
NPI | 1083053201 |
---|---|
Provider Name | Dr. Kristie Petree |
First Address | Philadelphia, PA 19182-4112 |
Second Address | Suwanee, GA 30024-2937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 17/07/2017 |