Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 78171 | GA |
N | 207KA0200X | Allergist | 71871 | GA |
NPI | 1033343439 |
---|---|
Provider Name | Marissa Shams |
First Address | Atlanta, GA 30322-1015 |
Second Address | Atlanta, GA 30322-1015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2009 |
Last Update Date | 02/08/2014 |