Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CHIR003045 | GA |
NPI | 1194943175 |
---|---|
Provider Name | Dr. Michelle A Leroy-Lawrence |
First Address | Canton, GA 30115-9186 |
Second Address | Woodstock, GA 30189-5540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |