Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 052636 | GA |
NPI | 1073551503 |
---|---|
Provider Name | Dr. Dyan M Spinnato |
First Address | North Augusta, SC 29860-9742 |
Second Address | Evans, GA 30809-3058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 08/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
190988196A | (05) | GA |
190988196C | (05) | GA |