Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 031652 | GA |
NPI | 1063512465 |
---|---|
Provider Name | Susan M Ray |
First Address | Atlanta, GA 30308 |
Second Address | Atlanta, GA 30308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 10/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F61274 | (02) | GA |