Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1972075117 |
---|---|
Provider Name | Alan Medford |
First Address | Atlanta, GA 30319-1042 |
Second Address | Atlanta, GA 30319-1042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2018 |
Last Update Date | 28/12/2018 |