Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 074601 | GA |
NPI | 1053554311 |
---|---|
Provider Name | Kami Strong |
First Address | Chicago, IL 60611-4264 |
Second Address | Jonesboro, GA 30236-2744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2009 |
Last Update Date | 20/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
074601 | LICENSE (01) | GA |