Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CHIRO02185 | GA |
NPI | 1447507223 |
---|---|
Provider Name | Dr. Suzanne Butler |
First Address | Greensboro, GA 30642-2553 |
Second Address | Greensboro, GA 30642-2553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2012 |
Last Update Date | 10/08/2012 |