Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 4537 | LA |
NPI | 1194944645 |
---|---|
Provider Name | Dr. Gerard Jules Chiche |
First Address | Augusta, GA 30912-0004 |
Second Address | Augusta, GA 30912-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 12/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
418431597A | (05) | GA |
ZG0351 | (05) | SC |