Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 12002 | SC |
NPI | 1164473302 |
---|---|
Provider Name | Mary K Neuffer |
First Address | Atlanta, GA 30384-2145 |
Second Address | Columbia, SC 29201-2942 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 30/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120023 | (05) | SC |
AA97649505 | MEDICARE PTAN (01) | SC |
B92261 | (02) | SC |