Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 001759 | GA |
NPI | 1083839393 |
---|---|
Provider Name | Dr. Clement Anyanwu |
First Address | Augusta, GA 30907-3249 |
Second Address | Augusta, GA 30912-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |