Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | PENDING | GA |
NPI | 1124604889 |
---|---|
Provider Name | Kaitlin Neese |
First Address | Cumming, GA 30040-4702 |
Second Address | Cumming, GA 30040-4702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2021 |
Last Update Date | 10/09/2021 |