Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 056573 | GA |
N | 2080P0208X | Pediatric Infectious Diseases | 056573 | GA |
NPI | 1114915055 |
---|---|
Provider Name | Lilly Hsi Chih Immergluck |
First Address | Atlanta, GA 30310 |
Second Address | Atlanta, GA 30303-3032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 05/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G19353 | (02) |