Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1245473438 |
---|---|
Provider Name | Georgia Mae Brazzell |
First Address | Holly Hill, FL 32117-3310 |
Second Address | Holly Hill, FL 32117-3310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2009 |
Last Update Date | 17/04/2009 |