Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | 47327 | GA |
NPI | 1023082005 |
---|---|
Provider Name | Abdul Hafeez |
First Address | Lawrenceville, GA 30046 |
Second Address | Lawrenceville, GA 30046-3367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 12/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G29338 | (02) | GA |