Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 28452 | AL |
Y | 111NI0900X | Internist | 28452 | AL |
NPI | 1003086349 |
---|---|
Provider Name | Dr. Bobby Andreson Crocker |
First Address | Atlanta, GA 30317 |
Second Address | Calera, AL 35040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2008 |
Last Update Date | 03/03/2008 |