Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | 006694 | GA |
N | 207R00000X | Internist | 006694 | GA |
N | 111NI0900X | Internist | 006694 | GA |
N | 111NN0400X | Neurology | 006694 | GA |
N | 111NN1001X | Nutrition | 006694 | GA |
N | 111NR0200X | Radiology | 006694 | GA |
N | 213ER0200X | Radiology | 006694 | GA |
N | 111NR0400X | Rehabilitation Chiropractor | 006694 | GA |
N | 111NS0005X | Chiropractic Sports Physician | 006694 | GA |
N | 111NT0100X | Thermography | 006694 | GA |
N | 111NX0100X | Occupational Health | 006694 | GA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 006694 | GA |
NPI | 1871706788 |
---|---|
Provider Name | Dr. Lacretia Tatham Munroe |
First Address | Canton, GA 30115 |
Second Address | Canton, GA 30115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2007 |