Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 010652 | GA |
NPI | 1659391019 |
---|---|
Provider Name | Asif Taufiq |
First Address | Lawrenceville, GA 30043-5491 |
Second Address | Lawrenceville, GA 30043-5491 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |