Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIRO 002079 | GA |
NPI | 1003893231 |
---|---|
Provider Name | Dr. Gary P Fish |
First Address | Roswell, GA 30075-2503 |
Second Address | Roswell, GA 30075-2503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 16/05/2008 |