Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 87896 | GA |
NPI | 1073045449 |
---|---|
Provider Name | Tra V Pham |
First Address | Atlanta, GA 30303-3033 |
Second Address | Detroit, MI 48202-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2017 |
Last Update Date | 07/06/2021 |