Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 030893 | GA |
NPI | 1003966094 |
---|---|
Provider Name | Dr. G Anthony Slagel |
First Address | Atlanta, GA 30368-2321 |
Second Address | Fayetteville, GA 30214-1568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 17/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D99803 | (02) | GA |