Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 40898 | GA |
NPI | 1124453337 |
---|---|
Provider Name | Ladi Doonquah |
First Address | Decatur, GA 30034-1649 |
Second Address | Decatur, GA 30034-1649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2013 |
Last Update Date | 06/09/2013 |