Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 000628 | GA |
Y | 222Z00000X | Podiatrist | 000628 | GA |
N | 213EP1101X | Primary Podiatric Medicine | 000628 | GA |
N | 111NR0200X | Radiology | 000628 | GA |
N | 213ER0200X | Radiology | 000628 | GA |
N | 2081S0010X | Sports Medicine | 000628 | GA |
N | 213ES0000X | Sports Medicine | 000628 | GA |
N | 213ES0103X | Foot & Ankle Surgery | 000628 | GA |
NPI | 1457481558 |
---|---|
Provider Name | Georgina Asante |
First Address | Columbus, GA 31901-3600 |
Second Address | Columbus, GA 31901-3600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 17/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000452856C | (05) | GA |
673506 | BLUE CROSS BLUE SHIELD (01) | GA |
U13517 | (02) |