Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 000619 | GA |
Y | 222Z00000X | Podiatrist | 000619 | GA |
N | 213ES0131X | Foot Surgery | 000619 | GA |
NPI | 1275643710 |
---|---|
Provider Name | Dr. Latanya P. Fyne |
First Address | Augusta, GA 30904-5850 |
Second Address | Augusta, GA 30904-5850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 04/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GPD619 | (05) | SC |
U30626 | (02) | GA |