Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 000996 | GA |
NPI | 1407833015 |
---|---|
Provider Name | Dr. Marieli A Colon |
First Address | Forest Park, GA 30297-2185 |
Second Address | Forest Park, GA 30297 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2005 |
Last Update Date | 23/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
510199753A | (05) | GA |
510199753B | (05) | GA |
V00157 | (02) |