Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic |
NPI | 1568477040 |
---|---|
Provider Name | Mrs. Sheila Denise Bousson |
First Address | Decatur, GA 30033-4004 |
Second Address | Decatur, GA 30033-4004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 08/07/2007 |