Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 041397 | GA |
NPI | 1053317917 |
---|---|
Provider Name | Laura M. Zucker |
First Address | Roswell, GA 30076-5720 |
Second Address | Roswell, GA 30076-5720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00703964A | (05) | GA |