Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 033283 | GA |
NPI | 1134181548 |
---|---|
Provider Name | Dr. Albert Vincent Brawley |
First Address | Martinez, GA 30907-9130 |
Second Address | Augusta, GA 30901-2612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00542297B | (05) | GA |
E58465 | (02) | GA |