Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 069355 | GA |
N | 208000000X | Pediatrician | MD60084840 | WA |
N | 2080A0000X | Adolescent Medicine | MD60084840 | WA |
N | 2080N0001X | Neonatal-Perinatal Doctor | MD60084840 | WA |
NPI | 1073849337 |
---|---|
Provider Name | Noreen Mian |
First Address | Tifton, GA 31794-3643 |
Second Address | Tifton, GA 31794-3648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2009 |
Last Update Date | 18/06/2015 |