Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0000X | Obstetrician | 27671 | GA |
Y | 207VX0201X | Gynecologic Oncologist | 27671 | GA |
NPI | 1578590469 |
---|---|
Provider Name | Dr. Cyril Spann JR. |
First Address | Decatur, GA 30033-6131 |
Second Address | Atlanta, GA 30318-0921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 26/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C89511001 | (02) | GA |