Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN011787 | GA |
Y | 213EG0000X | General Practice | DN011787 | GA |
NPI | 1003822156 |
---|---|
Provider Name | Dr. J. Walker Love |
First Address | Atlanta, GA 30338-5150 |
Second Address | Atlanta, GA 30338-5150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |