Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 042829 | NY |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 042829 | NY |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN015385 | GA |
N | 1223X0008X | Oral and Maxillofacial Radiology | 042829 | NY |
N | 1223X0400X | Orthodontists | 042829 | NY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 042829 | NY |
NPI | 1780649202 |
---|---|
Provider Name | Dr. Stephanie Joy Drew |
First Address | Atlanta, GA 30322-1013 |
Second Address | Atlanta, GA 30322-4405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 08/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01463525 | (05) | NY |
U40689 | (02) | NY |