Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 042167 | GA |
NPI | 1225095136 |
---|---|
Provider Name | David A Bakken |
First Address | Atlanta, GA 30345-3540 |
Second Address | Atlanta, GA 30342-1605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 13/11/2007 |