Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5746 | GA |
NPI | 1003171166 |
---|---|
Provider Name | Rana Botlani Esfahani |
First Address | Morrow, GA 30260-4180 |
Second Address | Morrow, GA 30260-4180 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2012 |
Last Update Date | 05/07/2012 |