Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | MD33638 | DC |
NPI | 1215015466 |
---|---|
Provider Name | Shana S Jacobs |
First Address | Atlanta, GA 30374-4785 |
Second Address | Washington, DC 20010-2978 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 02/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I39949 | (02) |