Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 039143 | GA |
Y | 207VG0400X | Gynecologist | 039143 | GA |
N | 207VX0000X | Obstetrician | 039143 | GA |
NPI | 1124053384 |
---|---|
Provider Name | Dr. Supreeti K Khurana |
First Address | Macon, GA 31221-7690 |
Second Address | Macon, GA 31201-2173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 28/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000720409J | (05) | GA |
G43643 | (02) | GA |