Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | POD001059 | GA |
NPI | 1003012949 |
---|---|
Provider Name | Dr. Pinecca J Patel-Raval |
First Address | Atlanta, GA 30342-1703 |
Second Address | Cumming, GA 30040-0307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 19/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2320170 | CIGNA (01) | GA |