Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 008745 | GA |
N | 111N00000X | Chiropractor | 010359 | PA |
N | 111NI0013X | Independent Medical Examiner | 010359 | PA |
N | 111NI0013X | Independent Medical Examiner | CHIR008745 | GA |
NPI | 1235431701 |
---|---|
Provider Name | Dr. Demitrious Gilmore |
First Address | Roswell, GA 30076-2030 |
Second Address | Roswell, GA 30076-2030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2010 |
Last Update Date | 03/12/2010 |