Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 063349 | GA |
N | 207W00000X | Ophthalmologist | 063349 | GA |
NPI | 1427266055 |
---|---|
Provider Name | Suma P Shankar |
First Address | Decatur, GA 30033-5307 |
Second Address | Decatur, GA 30033-5307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 15/10/2009 |