Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 18675 | GA |
NPI | 1295805570 |
---|---|
Provider Name | Dr. G. Courtney Houston |
First Address | Thomasville, GA 31792-6644 |
Second Address | Thomasville, GA 31792-6644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 12/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000210779A | (05) | GA |
238212HO | BCBS (01) | GA |
D40184 | (02) | GA |