Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | POD000796 | GA |
Y | 213ES0000X | Sports Medicine | POD000796 | GA |
N | 213ES0103X | Foot & Ankle Surgery | POD000796 | GA |
NPI | 1184684862 |
---|---|
Provider Name | Charles Fink Peebles |
First Address | Atlanta, GA 30342-1150 |
Second Address | Atlanta, GA 30342-1150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2006 |
Last Update Date | 02/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
160059112A | (05) | GA |