Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 009139 | GA |
N | 207QA0401X | Family Doctor - Addiction Medicine | 20207QA0401X | GA |
NPI | 1760914733 |
---|---|
Provider Name | Jennifer C Achebe |
First Address | Macon, GA 31206-0800 |
Second Address | Macon, GA 31206-0800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2017 |
Last Update Date | 14/03/2019 |