Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 034814 | GA |
NPI | 1023040417 |
---|---|
Provider Name | Dr. Sarah Elizabeth Derossett |
First Address | Decatur, GA 30033-6149 |
Second Address | Decatur, GA 30033-6149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00476352C | (05) | GA |
F18046 | (02) | GA |