Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CO090505 | GA |
NPI | 1245607324 |
---|---|
Provider Name | Lavon Morrow |
First Address | Marietta, GA 30064-4568 |
Second Address | Marietta, GA 30064-4568 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2015 |
Last Update Date | 25/08/2015 |