Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 200200636 | NC |
NPI | 1083620280 |
---|---|
Provider Name | Clinton Kesler Atkinson |
First Address | Pinehurst, NC 28374 |
Second Address | Pinehurst, NC 28374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 06/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5901577 | (05) | NC |
H83147 | (02) | NC |