Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | G060249 | CA |
NPI | 1821164500 |
---|---|
Provider Name | Booker Terry Seymour III |
First Address | Atlanta, GA 30327 |
Second Address | Atlanta, GA 30327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00663891A | (05) | GA |
E52403 | (02) |