Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 051895 | GA |
NPI | 1013097971 |
---|---|
Provider Name | Amsel Melka Siore |
First Address | Snellville, GA 30078 |
Second Address | Snellville, GA 30078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043439752A | (05) | GA |
CD7170 | RAILROAD MEDICARE (01) | GA |
GRP2664 | GROUP MEDICARE # (01) | GA |
I33848 | (02) |