Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | NT | GA |
Y | 222Z00000X | Podiatrist | NT | GA |
NPI | 1013420413 |
---|---|
Provider Name | Mrs. Erika Allison |
First Address | Austell, GA 30168-4531 |
Second Address | Smyrna, GA 30082-5184 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2017 |
Last Update Date | 08/11/2017 |