Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 72821 | GA |
NPI | 1003176082 |
---|---|
Provider Name | Mrs. Joli Ann Mccarthy |
First Address | Stone Mountain, GA 30087 |
Second Address | Austell, GA 30106-1121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2012 |
Last Update Date | 26/09/2019 |