Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 86955 | GA |
NPI | 1093268138 |
---|---|
Provider Name | Carlos Andres Penaherrera Oviedo |
First Address | Dalton, GA 30722-1168 |
Second Address | Dalton, GA 30720-6310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2016 |
Last Update Date | 14/10/2021 |