Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 78184 | GA |
N | 207Q00000X | Family Doctor | LL35793 | SC |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD35793 | SC |
NPI | 1215376801 |
---|---|
Provider Name | Nithya Malti Natrajan |
First Address | Augusta, GA 30901-2607 |
Second Address | Augusta, GA 30901-2607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2013 |
Last Update Date | 17/03/2018 |