Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 035968 | GA |
NPI | 1013245372 |
---|---|
Provider Name | Dr. Brian M Palmer I |
First Address | Decatur, GA 30030-1707 |
Second Address | Decatur, GA 30030-1707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2009 |
Last Update Date | 08/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G53004 | (02) | GA |