Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 031942 | GA |
NPI | 1003860743 |
---|---|
Provider Name | Dr. Bobby Louis Herrington |
First Address | Lafayette, LA 70508-3870 |
Second Address | Hinesville, GA 31313-4000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000424102H | (05) | GA |
E64763 | (02) | GA |