Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 047097 | GA |
NPI | 1053413013 |
---|---|
Provider Name | Michael Francis Iademarco |
First Address | Decatur, GA 30033-4004 |
Second Address | Decatur, GA 30033-4004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |