Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 043112 | GA |
NPI | 1124154323 |
---|---|
Provider Name | Roel Nolido Querubin |
First Address | Atlanta, GA 30341-5630 |
Second Address | Lawrenceville, GA 30044-6985 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2007 |
Last Update Date | 07/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
690710060A | (05) | GA |
I15638 | (02) | GA |