Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD468290 | GA |
NPI | 1205274800 |
---|---|
Provider Name | Dr. Fernando David Nussenbaum |
First Address | Stockbridge, GA 30281-7237 |
Second Address | Stockbridge, GA 30281-7237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2013 |
Last Update Date | 27/08/2020 |