Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN012531 | GA |
Y | 213EG0000X | General Practice | DN012531 | GA |
NPI | 1003800392 |
---|---|
Provider Name | Dr. Darin S. Wasileski |
First Address | Snellville, GA 30078-0365 |
Second Address | Snellville, GA 30078-3498 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2005 |
Last Update Date | 08/07/2007 |