Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DN011324 | GA |
NPI | 1851499933 |
---|---|
Provider Name | Susan Muller |
First Address | Bluefield, WV 24701-1457 |
Second Address | Decatur, GA 30033-5918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 18/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000675298G | (05) | GA |
U56215 | (02) | GA |