Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CHIR010450 | GA |
NPI | 1447854021 |
---|---|
Provider Name | Mariko Kato |
First Address | Doraville, GA 30360-1746 |
Second Address | Doraville, GA 30360-1746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2020 |
Last Update Date | 24/11/2020 |