Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 24356 | GA |
NPI | 1053454389 |
---|---|
Provider Name | Sheryl Vernon Thacker |
First Address | Atlanta, GA 30308-2920 |
Second Address | Atlanta, GA 30308-2920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E48752 | (02) | GA |