Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 11758 | GA |
NPI | 1093744294 |
---|---|
Provider Name | Dr. Edwin Douglas Joy JR. |
First Address | Augusta, GA 30909-4502 |
Second Address | Augusta, GA 30909-4502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 21/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00138707C | (05) | GA |
906666 | (05) | SC |
U22315 | (02) |