Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 6786 | GA |
Y | 208600000X | Surgeon | 6786 | GA |
NPI | 1013322130 |
---|---|
Provider Name | Patricia Martinez Quinones |
First Address | Augusta, GA 30912-0004 |
Second Address | Augusta, GA 30912-0004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2014 |
Last Update Date | 26/06/2014 |