Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 080502 | GA |
Y | 208600000X | Surgeon | 080502 | GA |
N | 2086S0102X | Surgical Critical Care | 080502 | GA |
N | 2086S0127X | Trauma Surgeon | 080502 | GA |
NPI | 1003077249 |
---|---|
Provider Name | Dr. Dominic Joseph Papandria |
First Address | Atlanta, GA 30308-2212 |
Second Address | Atlanta, GA 30308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2008 |
Last Update Date | 23/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
86607U | (02) | NC |