Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 33418 | GA |
NPI | 1043239478 |
---|---|
Provider Name | Dr. Jeffrey J. Olson |
First Address | Stone Mountain, GA 30087-1715 |
Second Address | Atlanta, GA 30322-1013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A02499 | (02) | GA |