Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 061885 | GA |
N | 207T00000X | Neurosurgeon | G8850 | TX |
NPI | 1114954120 |
---|---|
Provider Name | Dr. Cole A. Giller |
First Address | Augusta, GA 30901-2602 |
Second Address | Augusta, GA 30912-0004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 30/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105029605 | (05) | TX |
105029606 | (05) | TX |
8BR087 | BCBS (01) | TX |
8P8211 | BCBS (01) | TX |
D48275 | (02) |