Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 14046 | GA |
NPI | 1417060112 |
---|---|
Provider Name | Dr. Ainsworth Gatewood Dudley |
First Address | Americus, GA 31709-0847 |
Second Address | Americus, GA 31709-3917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 01/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000014605G | (05) | GA |
52025110-001 | BCBS (01) | GA |
D45252 | (02) | GA |