Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN214578 | GA |
NPI | 1003226069 |
---|---|
Provider Name | Gopika Naidu |
First Address | Loganville, GA 30052-2310 |
Second Address | Loganville, GA 30052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2014 |
Last Update Date | 14/07/2014 |