Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 25990 | AL |
NPI | 1306954037 |
---|---|
Provider Name | Han Cam Phan |
First Address | Atlanta, GA 30345 |
Second Address | Atlanta, GA 30342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 27/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009992435 | (05) | AL |
009992445 | (05) | AL |
I29140 | (02) |