Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 007002 | GA |
NPI | 1831480698 |
---|---|
Provider Name | Dr. Carl Amodio |
First Address | Roswell, GA 30076-5612 |
Second Address | Roswell, GA 30076-5612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2011 |
Last Update Date | 28/04/2011 |