Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 033654 | GA |
N | 111NI0900X | Internist | 033654 | GA |
Y | 207RC0200X | Critical Care Medicine | 033654 | GA |
N | 207RP1001X | Pulmonary Disease | 033654 | GA |
N | 207RS0012X | Sleep Medicine | 033654 | GA |
NPI | 1083604532 |
---|---|
Provider Name | Dr. Anthony Kimani Mwangi |
First Address | Canton, GA 30114-2408 |
Second Address | Canton, GA 30114-2408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 16/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000608297E | (05) | GA |
F82002 | (02) | GA |