Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 069630 | GA |
NPI | 1033490743 |
---|---|
Provider Name | Jolina Pamela C Santos |
First Address | Griffin, GA 30224-4214 |
Second Address | Griffin, GA 30224-4214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2011 |
Last Update Date | 20/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003133683A | (05) | GA |
5206370 | CIGNA (01) | GA |