Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 020838 | GA |
NPI | 1033197579 |
---|---|
Provider Name | Dr. Andrew Tice |
First Address | Macon, GA 31211-1435 |
Second Address | Macon, GA 31211-1435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 08/07/2007 |