Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DN011342 | GA |
NPI | 1932521481 |
---|---|
Provider Name | Dr. Ximena Zornosa |
First Address | Peachtree City, GA 30269-4276 |
Second Address | Decatur, GA 30030-1726 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2014 |
Last Update Date | 16/01/2014 |