Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 026516 | GA |
NPI | 1003926569 |
---|---|
Provider Name | David B. Flannery |
First Address | Augusta, GA 30901-2602 |
Second Address | Augusta, GA 30912-0004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 21/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000288582A | (05) | GA |
D29497 | (02) | |
G26516 | (05) | SC |