Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 031554 | GA |
Y | 2080P0201X | Pediatric Allergist | 031554 | GA |
N | 2080P0201X | Pediatric Allergist | 31554 | GA |
NPI | 1518027457 |
---|---|
Provider Name | Dr. Mary Hamilton Anderson |
First Address | Evans, GA 30809-3089 |
Second Address | Evans, GA 30809-3089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 29/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000555981B | (05) | GA |
000555981C | (05) | GA |
000555981D | (05) | GA |