Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | RN203407 | GA |
NPI | 1235684192 |
---|---|
Provider Name | Heather Raborn |
First Address | Augusta, GA 30903-1705 |
Second Address | Augusta, GA 30901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2016 |
Last Update Date | 12/06/2018 |