Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 055685 | GA |
NPI | 1659332922 |
---|---|
Provider Name | Mrs. Anu R Mongia |
First Address | Cartersville, GA 30121-8718 |
Second Address | Cartersville, GA 30121-8718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 14/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
915720405B | (05) | GA |