Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 041913 | GA |
N | 207N00000X | Dermatologist | 28766 | AL |
N | 207N00000X | Dermatologist | 427315 | PA |
N | 207ND0900X | Dermatopathologist | 041913 | GA |
N | 207ND0900X | Dermatopathologist | 28766 | AL |
N | 207ND0900X | Dermatopathologist | 427315 | PA |
NPI | 1356333645 |
---|---|
Provider Name | Paula M. Nelson |
First Address | Lilburn, GA 30047-3401 |
Second Address | Lilburn, GA 30047-3401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 23/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F88798 | (02) | GA |