Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 296995 | NY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 296995 | NY |
N | 207QA0505X | Family Doctor - Adult Medicine | 296995 | NY |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 296995 | NY |
NPI | 1568811008 |
---|---|
Provider Name | Dr. Cody Lee Andrews |
First Address | Dallas, TX 75208-1953 |
Second Address | Madison, GA 30650-4762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2016 |
Last Update Date | 14/12/2020 |