Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 3030 | GA |
N | 111NN1001X | Nutrition | 3030 | GA |
Y | 111NS0005X | Chiropractic Sports Physician | 3030 | GA |
NPI | 1518068089 |
---|---|
Provider Name | Lili D Gipson |
First Address | Acworth, GA 30102-0007 |
Second Address | Woodstock, GA 30189-2466 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 20/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
UO8409 | (02) | GA |