Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | LDO002839 | GA |
NPI | 1053076018 |
---|---|
Provider Name | Mrs. Na Jiang |
First Address | Augusta, GA 30907-8216 |
Second Address | Augusta, GA 30907-8216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2021 |
Last Update Date | 04/11/2021 |