Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 041106 | GA |
NPI | 1003915190 |
---|---|
Provider Name | Gabraella Drake-Forte |
First Address | Alpharetta, GA 30005 |
Second Address | Alpharetta, GA 30005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 29/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F41642 | (02) |