Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0131X | Foot Surgery | 569 | SC |
Y | 213ES0131X | Foot Surgery | POD001182 | GA |
NPI | 1093804817 |
---|---|
Provider Name | Dr. George Sich III |
First Address | Augusta, GA 30912-0004 |
Second Address | Aiken, SC 29803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 07/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V00166 | (02) | SC |