Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 20181041 | GA |
N | 208D00000X | General Practice Physician | 20181041 | GA |
NPI | 1700410867 |
---|---|
Provider Name | Reem Hudaib |
First Address | Lawrenceville, GA 30045-7281 |
Second Address | Lawrenceville, GA 30045-7281 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2020 |
Last Update Date | 27/02/2020 |