Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1205450954 |
---|---|
Provider Name | Monique D Gay |
First Address | Smyrna, GA 30081-1244 |
Second Address | Marietta, GA 30060-5241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2020 |
Last Update Date | 28/05/2020 |