Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 65011 | GA |
N | 2081S0010X | Sports Medicine | 65011 | GA |
N | 213ES0000X | Sports Medicine | 65011 | GA |
NPI | 1376747881 |
---|---|
Provider Name | Bogdan Cristian Jaliu |
First Address | Athens, GA 30606-3506 |
Second Address | Athens, GA 30606-3506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 16/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003106340A | (05) | GA |