Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 021058 | GA |
NPI | 1295785475 |
---|---|
Provider Name | Dr. Corbett Mark Thigpen |
First Address | Augusta, GA 30909-1867 |
Second Address | Augusta, GA 30909-1867 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00263172A | (05) | GA |
026876 | BCBS (01) | GA |
0519750 | AETNA (01) | GA |
0900126 | UHC (01) | GA |
D41223 | (02) | GA |
G21058 | (05) | SC |