Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 89351 | GA |
NPI | 1063809127 |
---|---|
Provider Name | Heather Anne Koehn |
First Address | Augusta, GA 30912-0004 |
Second Address | Augusta, GA 30912-0816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2015 |
Last Update Date | 01/07/2021 |