Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 581945565 | GA |
NPI | 1245458660 |
---|---|
Provider Name | Georgette Anthony |
First Address | Acworth, GA 30102 |
Second Address | Acworth, GA 30102-6923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 04/10/2013 |