Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN011493 | GA |
NPI | 1508971862 |
---|---|
Provider Name | Dr. Ruth Monina Klevens |
First Address | Atlanta, GA 30345-1916 |
Second Address | Decatur, GA 30033-4004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |