Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 64585 | GA |
NPI | 1013918721 |
---|---|
Provider Name | Mrs. Pushpa Lalaji |
First Address | Lawrenceville, GA 30044-5896 |
Second Address | Lawrenceville, GA 30044-5896 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 26/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64585 | LICENSE (01) | GA |
C07745 | (02) |