Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 11277 | GA |
NPI | 1134275910 |
---|---|
Provider Name | Mrs. Karen Samuels Horace |
First Address | Norcross, GA 30093 |
Second Address | Jonesboro, GA 30236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 08/07/2007 |