Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 018219 | GA |
N | 207XS0117X | Orthopaedic Spine Surgeon | 018219 | GA |
NPI | 1205838273 |
---|---|
Provider Name | Carl David Fackler |
First Address | Atlanta, GA 30309-1476 |
Second Address | Atlanta, GA 30309-1476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D39826 | (02) |