Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN012655 | GA |
Y | 213EG0000X | General Practice | DN012655 | GA |
NPI | 1003905811 |
---|---|
Provider Name | Dr. Rina M Mehta |
First Address | Marietta, GA 30064-2567 |
Second Address | Marietta, GA 30064-2567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 10/09/2008 |