Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN012845 | GA |
Y | 1223P0221X | Pediatric Dentist | DN012845 | GA |
NPI | 1033220215 |
---|---|
Provider Name | Erin M Redwine |
First Address | Lithia Springs, GA 30122-1591 |
Second Address | Lithia Springs, GA 30122-1591 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 15/03/2017 |