Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 037025 | GA |
NPI | 1174676829 |
---|---|
Provider Name | Dr. Daniel Thomas Mcdevitt |
First Address | Stockbridge, GA 30281-6118 |
Second Address | Stockbridge, GA 30281-6118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 17/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000546521C | (05) | GA |
0486348 | AETNA (01) | GA |
1861090-012 | CIGNA (01) | GA |
281529 | WELLCARE CHOICE PLAN (01) | GA |
52451306002 | BLUE CROSS BLUE SHIELD (01) | GA |
581800973 | UNITED HEALTHCARE (01) | GA |
770001325 | MEDICARE RAILROAD (01) | GA |
F05885 | (02) | GA |