Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 050616 | GA |
NPI | 1073589909 |
---|---|
Provider Name | Dr. Gary Eddy SR. |
First Address | Macon, GA 31201-2100 |
Second Address | Macon, GA 31201-2100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 21/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000920598C | (05) | GA |
D05776 | (02) | GA |