Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | R053661 | GA |
NPI | 1376566893 |
---|---|
Provider Name | Jane Mashburn |
First Address | Decatur, GA 30033-5529 |
Second Address | Atlanta, GA 30308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S89452002 | (02) | GA |