Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 048291 | GA |
NPI | 1215931555 |
---|---|
Provider Name | Vanitcha R Pintavorn |
First Address | Evans, GA 30809-3091 |
Second Address | Evans, GA 30809-3091 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 11/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000894154D | (05) | GA |
G48291 | (05) | SC |
H33363 | (02) | GA |