Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 65409 | GA |
NPI | 1003080524 |
---|---|
Provider Name | Qiuping A Pan |
First Address | Atlanta, GA 30341-5680 |
Second Address | Dublin, GA 31021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2008 |
Last Update Date | 20/02/2012 |