Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CHIR005136 | GA |
NPI | 1861522955 |
---|---|
Provider Name | Dr. James Lawrence Duffy |
First Address | Marietta, GA 30062-3585 |
Second Address | Marietta, GA 30062-3585 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 28/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T64324 | (02) | GA |