Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 72115 | GA |
NPI | 1093078305 |
---|---|
Provider Name | Rossana Lucia Sanchez Russo |
First Address | Decatur, GA 30322 |
Second Address | Atlanta, GA 30322-5307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2012 |
Last Update Date | 19/09/2017 |