Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 077649 | GA |
Y | 208600000X | Surgeon | 077649 | GA |
NPI | 1013280353 |
---|---|
Provider Name | Dr. George Joseph Myers IV |
First Address | Bainbridge, GA 39819-4256 |
Second Address | Bainbridge, GA 39819-4355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2012 |
Last Update Date | 19/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003190187B | (05) | GA |
077649 | MEDICAL LICENSE (01) | GA |