Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 052032 | GA |
NPI | 1124182886 |
---|---|
Provider Name | Monique Welsh-Evans |
First Address | Lawrenceville, GA 30046 |
Second Address | Lawrenceville, GA 30046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 15/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
711650071A | (05) | GA |