Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 022515 | GA |
NPI | 1003853177 |
---|---|
Provider Name | Dr. Gary Robert Botstein |
First Address | Decatur, GA 30033-5930 |
Second Address | Decatur, GA 30033-5930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 28/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00252315B | (05) | GA |
B91366 | (02) | GA |