Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 31072 | GA |
NPI | 1396787602 |
---|---|
Provider Name | Lillian Meacham |
First Address | Atlanta, GA 30342-3283 |
Second Address | Atlanta, GA 30342-3283 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 25/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E97177 | (02) |