Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH8431 | FL |
NPI | 1477551430 |
---|---|
Provider Name | Dr. George S Petryk |
First Address | Cumming, GA 30040-9735 |
Second Address | Cumming, GA 30040-9735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 10/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U70967 | (02) | FL |