Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 10743 | GA |
NPI | 1134248362 |
---|---|
Provider Name | Dr. Jay Smith |
First Address | Atlanta, GA 30309-3915 |
Second Address | Atlanta, GA 30309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |