Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 5 | GA |
N | 222Z00000X | Podiatrist | 5 | GA |
Y | 224P00000X | Prosthetist | CPO02246 |
NPI | 1437583689 |
---|---|
Provider Name | Mrs. Viorika Soltanovich |
First Address | Johns Creek, GA 30097 |
Second Address | Johns Creek, GA 30097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2013 |
Last Update Date | 23/08/2013 |