Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 044978 | GA |
NPI | 1679666291 |
---|---|
Provider Name | Dennis R. Ownby |
First Address | Augusta, GA 30901-2650 |
Second Address | Augusta, GA 30912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 30/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000777147A | (05) | GA |
B48044 | (02) | |
G70542 | (05) | SC |