Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 61320 | TN |
N | 207N00000X | Dermatologist | 86364 | GA |
N | 207N00000X | Dermatologist | A122120 | CA |
N | 207N00000X | Dermatologist | ME140586 | FL |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 61320 | TN |
N | 207P00000X | Emergency Physician | A122120 | CA |
NPI | 1053602128 |
---|---|
Provider Name | Dr. Vlatka Agnetta |
First Address | Ringgold, GA 30736-5176 |
Second Address | Chattanooga, TN 37421-4904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2011 |
Last Update Date | 19/01/2021 |