Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 11044 | GA |
NPI | 1104906346 |
---|---|
Provider Name | Dr. Bryan Scott Geerlings |
First Address | Newnan, GA 30263-5813 |
Second Address | Newnan, GA 30263-5813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/07/2007 |