Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OD476 | TN |
NPI | 1013085323 |
---|---|
Provider Name | Dr. George A. Cunningham |
First Address | Mountain City, TN 37683-1308 |
Second Address | Mountain City, TN 37683-1308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3591620 | (05) | TN |
U01129 | (02) | TN |