Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 12440 | GA |
NPI | 1114242575 |
---|---|
Provider Name | Dr. Louisa S Berman |
First Address | Atlanta, GA 30319-3326 |
Second Address | Atlanta, GA 30306-3695 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2010 |
Last Update Date | 26/08/2011 |