Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CHIR009972 | GA |
NPI | 1558861906 |
---|---|
Provider Name | Dr. Dylan Michael Saulsbery |
First Address | Marietta, GA 30060-2943 |
Second Address | Marietta, GA 30060-2943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2018 |
Last Update Date | 12/02/2018 |