Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 75594 | GA |
NPI | 1093011249 |
---|---|
Provider Name | Stephanie Ambrose |
First Address | Atlanta, GA 30322-0001 |
Second Address | Atlanta, GA 30308-2212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2011 |
Last Update Date | 23/06/2016 |