Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 035842 | GA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 035842 | GA |
NPI | 1023084068 |
---|---|
Provider Name | Dr. James Cunningham |
First Address | Columbus, GA 31902-1038 |
Second Address | Columbus, GA 31901-1527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 17/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000508692E | (05) | GA |
000508692I | (05) | GA |
C14950 | (02) | GA |