Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 57.027682 | OH |
N | 111NI0900X | Internist | 57.027682 | OH |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 90113 | GA |
NPI | 1013379080 |
---|---|
Provider Name | Melissa Lau |
First Address | Lagrange, GA 30240-3871 |
Second Address | Lagrange, GA 30240-3871 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 07/09/2021 |