Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 67388 | GA |
NPI | 1275776106 |
---|---|
Provider Name | Glaivy Mokulu Jacqueline Batsuli |
First Address | Atlanta, GA 30322-1060 |
Second Address | Atlanta, GA 30322-1060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2009 |
Last Update Date | 14/03/2014 |