Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 030230 | GA |
NPI | 1023177854 |
---|---|
Provider Name | Dr. Bruce Collier Tierney |
First Address | Tucker, GA 30084-7342 |
Second Address | Tucker, GA 30084-7342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2006 |
Last Update Date | 08/07/2007 |