Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 006922 | GA |
NPI | 1033233648 |
---|---|
Provider Name | Dr. James S Tate |
First Address | Atlanta, GA 30339-3918 |
Second Address | Atlanta, GA 30339-3918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5811295333 | FED TIN (01) |