Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CHIR009591 | GA |
NPI | 1396102281 |
---|---|
Provider Name | Dr. Elias Druckman |
First Address | Marietta, GA 30068-5012 |
Second Address | Marietta, GA 30067-8469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2016 |
Last Update Date | 22/01/2016 |