Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 73875 | GA |
NPI | 1154687721 |
---|---|
Provider Name | Dr. Tina Kim Vothang |
First Address | Marietta, GA 30062-6215 |
Second Address | Marietta, GA 30062-6215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2012 |
Last Update Date | 30/09/2019 |