Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 07578 | GA |
NPI | 1063776904 |
---|---|
Provider Name | Dr. Gil A Diaz Vega |
First Address | Decatur, GA 30033-4004 |
Second Address | Decatur, GA 30033-4004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2012 |
Last Update Date | 15/02/2017 |