Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | POD000953 | GA |
NPI | 1003908138 |
---|---|
Provider Name | Dr. James Austin Denmark |
First Address | Augusta, GA 30904-4764 |
Second Address | Augusta, GA 30904-4764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 30/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00972903A | (05) | GA |
U92338 | (02) | GA |