Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 85850 | GA |
Y | 111NI0900X | Internist | 85850 | GA |
N | 207RP1001X | Pulmonary Disease | 08523334 | TX |
NPI | 1023472925 |
---|---|
Provider Name | Dr. Susan Uchenna Otaluka |
First Address | Acworth, GA 30101-2745 |
Second Address | Rome, GA 30165-5621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2016 |
Last Update Date | 14/07/2020 |