Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | POD001012 | GA |
Y | 222Z00000X | Podiatrist | POD001012 | GA |
NPI | 1003850983 |
---|---|
Provider Name | Dr. Christopher Russel Corwin |
First Address | Atlanta, GA 30339-3084 |
Second Address | Johns Creek, GA 30097-3515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 19/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003132092B | (05) | GA |