Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 65188 | GA |
NPI | 1053612101 |
---|---|
Provider Name | Dr. Shaya Taghechian |
First Address | Mcdonough, GA 30253-4310 |
Second Address | Marietta, GA 30060-7282 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2010 |
Last Update Date | 14/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003110961A | (05) | GA |
FT2339439 | DEA (01) |