Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 0101254047 | VA |
N | 207RP1001X | Pulmonary Disease | 0101254047 | VA |
N | 207RP1001X | Pulmonary Disease | 24528 | TN |
Y | 207RP1001X | Pulmonary Disease | 37412 | GA |
N | 207RS0012X | Sleep Medicine | 0101254047 | VA |
NPI | 1003805722 |
---|---|
Provider Name | Andrew N Vernon |
First Address | Columbus, GA 31908-8147 |
Second Address | Columbus, GA 31904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 30/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003805722 | (05) | VA |
E76470 | (02) | TN |