Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 053255 | GA |
NPI | 1417960931 |
---|---|
Provider Name | David Kooby |
First Address | Atlanta, GA 30322-1013 |
Second Address | Atlanta, GA 30322-1013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014558 | BCBS (01) | GA |
2317218 | UNITED HEALTHCARE (01) | GA |
3247452 | US HEALTHCARE (01) | GA |
H89627 | (02) | GA |