Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | CHIR008276 | GA |
NPI | 1700044179 |
---|---|
Provider Name | Dr. Nova A. Grande |
First Address | Cumming, GA 30041-7235 |
Second Address | Cumming, GA 30041-7235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2008 |
Last Update Date | 02/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1487830253 | NPI GROUP # (01) | GA |