Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 51424 | GA |
NPI | 1003870874 |
---|---|
Provider Name | Renee Alli |
First Address | Chamblee, GA 30341-2724 |
Second Address | Chamblee, GA 30341-2724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 25/06/2021 |