Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DNF000346 | GA |
NPI | 1225294408 |
---|---|
Provider Name | Dr. Jimmy Londono |
First Address | Augusta, GA 30912-0002 |
Second Address | Augusta, GA 30912-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2008 |
Last Update Date | 25/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
872677118A | (05) | GA |
ZG0346 | (05) | SC |