Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 028117 | GA |
NPI | 1205928355 |
---|---|
Provider Name | Daniel Ray Gaskin, Jr. |
First Address | Savannah, GA 31406-3628 |
Second Address | Savannah, GA 31406-3628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 21/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D45414 | (02) | GA |