Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 052962 | GA |
NPI | 1144205279 |
---|---|
Provider Name | Noureen Noor Husain |
First Address | Smyrna, GA 30080-2065 |
Second Address | Smyrna, GA 30080-2065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 11/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
450924769A | (05) | GA |