Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 7483 | GA |
NPI | 1003299793 |
---|---|
Provider Name | Janelle Mcgill |
First Address | Augusta, GA 30912-0004 |
Second Address | Augusta, GA 30912-0004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2015 |
Last Update Date | 05/07/2018 |