Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN010537 | GA |
NPI | 1033608971 |
---|---|
Provider Name | Dr. John Anderson Clinebell |
First Address | Decatur, GA 30033-1006 |
Second Address | Decatur, GA 30033-1006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2018 |
Last Update Date | 07/05/2018 |